Commercial
  
  
  
  
  
  
  
  
  
  
  
MPattachmentdataPub
  
85256AA800623D7A8525854B006B2536.aspx
  
2443Radiation Therapy Services (AmeriHealth)Radiology (09)09.00.56k09.00.56Radiation Therapy Services (AmeriHealth)Radiation Therapy Services (AmeriHealth)7/31/2020 12:00 AM85256AA800623D7A8525854B006B2536
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10/1/2020
56f46a5f-01eb-445d-bd7c-140183617a62.aspx
  
2458SkilledNursingFacility(SNF):SkilledandSubacuteLevelsofCare02.03.00Case Management (02)02.03.0002.03.00Skilled Nursing Facility (SNF): Skilled and Subacute Levels of CareSkilled Nursing Facility (SNF): Skilled and Subacute Levels of Care9/1/2020 12:00 PM56f46a5f-01eb-445d-bd7c-140183617a62
10/1/2020
85256AA800623D7A8525856000624EDF.aspx
  
1909Radiologic Guidance and/or Supervision and Interpretation of a ProcedureAdministrative (00)00.10.36r00.10.36Radiologic Guidance and/or Supervision and Interpretation of a ProcedureRadiologic Guidance and/or Supervision and Interpretation of a Procedure7/14/2020 12:00 AM85256AA800623D7A8525856000624EDF
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10/12/2020
85256AA800623D7A85258514005AE163.aspx
  
2441Short-term Interstitial Continuous Glucose Monitoring Systems (CGMSs)DME (05)05.00.24r05.00.24Short-term Interstitial Continuous Glucose Monitoring Systems (CGMSs)Short-term Interstitial Continuous Glucose Monitoring Systems (CGMSs)7/28/2020 12:00 AM85256AA800623D7A85258514005AE163
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10/26/2020
85256AA800623D7A85258514005AEC5E.aspx
  
2442Insulin Pumps and Long-Term Interstitial Continuous Glucose Monitoring SystemsDME (05)05.00.79c05.00.79Insulin Pumps and Long-Term Interstitial Continuous Glucose Monitoring SystemsInsulin Pumps and Long-Term Interstitial Continuous Glucose Monitoring Systems7/28/2020 12:00 AM85256AA800623D7A85258514005AEC5E
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10/26/2020
faa50be1-657d-4d20-a6a5-87611074c3ab.aspx
  
2455crizanlizumab-tmca(Adakveo®)08.00.04Pharmacy (08)08.00.0408.00.04crizanlizumab-tmca (Adakveo®)crizanlizumab-tmca (Adakveo®)9/1/2020 12:00 PMfaa50be1-657d-4d20-a6a5-87611074c3ab
11/30/2020
583e6bf5-cdea-413d-87bd-b14f69d38ed8.aspx
  
2456MedicalandSurgicalTreatmentofTemporomandibularJointDisorder07.08.03fMedicine (07)07.08.03f07.08.03Medical and Surgical Treatment of Temporomandibular Joint DisorderMedical and Surgical Treatment of Temporomandibular Joint Disorder9/1/2020 12:00 PM583e6bf5-cdea-413d-87bd-b14f69d38ed8
11/30/2020
87a9c444-e54f-44ed-b39a-7d483abb7730.aspx
  
2457TriggerPointInjections11.14.02pSurgery (11)11.14.02p11.14.02Trigger Point InjectionsTrigger Point Injections9/1/2020 12:00 PM87a9c444-e54f-44ed-b39a-7d483abb7730
11/30/2020
e584361e-30fc-49e9-bae2-5c6da8d626f8.aspx
  
2459Eculizumab(Soliris®)andRelatedBiosimilars,Ravulizumab-cwvz(Ultomiris®)08.00.84hPharmacy (08)08.00.84h08.00.84Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris®)Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris®)9/1/2020 3:00 PMe584361e-30fc-49e9-bae2-5c6da8d626f8
11/30/2020