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Text File  |  1996-02-07  |  72KB  |  219 lines
  1. 217   0     32911  10211 3000  0 00  0 00  0                                                                                                                                                                                                                                                                                           
  2. C17110     Wart Removal                  17110     17110        15.00   0.00           A                                                                                                                                                                                                                N                              
  3. C29130     App. of Finger Splint, Static 29130     29130        30.00   5.00           A                                                                                                                                                                                                                N                              
  4. K36215     Lab Drawing Fee               36215     36215     5  8.00    3.00           A                                                                                                                                                                                                        0.00    N                              
  5. C70250     X-Ray, Skull, 4 Views         70250     70250     4  55.00   0.00           A                                                                                                                                                                                                                N                              
  6. C70360     X-Ray, Neck                   70360     70360        45.00   0.00           A                                                                                                                                                                                                                N                              
  7. L70373     X-Ray, Laryngography          70373     70373        45.00   0.00           A                                                                                                                                                                                                                N                              
  8. C71020     X-Ray, Chest, 2 Views         71020     71020     4  53.00   0.00           A                                                                                                                                                                                                                N                              
  9. C71030     X-Ray, Chest, Min 4 Views     71030     71030     4  65.00   0.00           A                                                                                                                                                                                                                N                              
  10. K72052     X-Ray, Spinal, Complete       72052     72052        80.00   0.00           A                                                                                                                                                                                                                N                              
  11. C73130     X-Ray, Hand, Min 3 Views      73130     73130     4  45.00   0.00           A                                                                                                                                                                                                                N                              
  12. C73562     X-Ray, Knee, Mn 3 Views       73562     73562     4  45.00   0.00           A                                                                                                                                                                                                                N                              
  13. C73610     X-Ray, Ankle, Complete        73610     73610     4  55.00   0.00           A                                                                                                                                                                                                                N                              
  14. L74246     MRI-Gastrointestinal Tract    74246     74246     5  80.00   0.00           A                                                                                                                                                                                                                N                              
  15. C76818     U. S. Fetal Age               76818     76818        37.00   0.00           A                                                                                                                                                                                                                N                              
  16. L80050     General Health Screen Panel   80050     80050        45.00   0.00           A                                                                                                                                                                                                                N                              
  17. K81000     Urinalysis, Routine           81000     81000     1  11.00   4.00           A                                                                                                                                                                                                                N                              
  18. C82947     Blood Sugar Lab Test          82947     82947     5  25.00   12.00          A                                                                                                                                                                                                        25.00   N                              
  19. K84702     Pregnancy Test, Gonadotropin  84702     84702        25.00   12.00          A                                                                                                                                                                                                                N                              
  20. C86006     UCG-Qualitative Test Urine    86006     86006     5  10.00   0.00           A                                                                                                                                                                                                                N                              
  21. C86300     Heterophile Antibod/ Mono Test86300     86300     5  10.00   0.00           A                                                                                                                                                                                                                N                              
  22. C86585     Tuberculosis, Tine, Skin Test 86585     86585     5  7.50    0.00           A                                                                                                                                                                                                                N                              
  23. C87072     Culture, Strep Screen         87072     87072     5  15.00   0.00           A                                                                                                                                                                                                                N                              
  24. C87087     Commercial Kit                87087     87087     9  25.00   0.00           A                                                                                                                                                                                                                N                              
  25. C90707     Immunization-MMR              90707     90707     9  10.00   0.00           A                                                                                                                                                                                                                N                              
  26. C90724     Influenza Virus Vaccine       90724     90724        10.00   0.00           A                                                                                                                                                                                                                N                              
  27. C90762     Well Child Exam, 5-11 yrs.    90762     90762     1  50.00   0.00           A                                                                                                                                                                                                                N                              
  28. C90900     Biofeedback Training          90900     90900        40.00   0.00           A                                                                                                                                                                                                                N                              
  29. C91105     Pump Stomach for Poison       91105     91105        50.00   0.00           A                                                                                                                                                                                                        40.00   N                              
  30. C93000     Electrocardiogram-Interp/Reprt93000     93000     1  45.00   0.00           A                                                                                                                                                                                                        40.00   N                              
  31. C93015     YR Treadmill                  93015     93015     1  350.00  0.00           A                                                                                                                                                                                                                N                              
  32. C95041     Allergy Patch Test, up to 10  95041     95041        30.00   3.00           A                                                                                                                                                                                                                N                              
  33. C95115     Allergy Injection  1          95115     95115        7.00    0.00           A                                                                                                                                                                                                                N                              
  34. C97010     Hot/Cold Pack Therapy         97010     97010     9  10.00   0.00           A                                                                                                                                                                                                                N                              
  35. C97086     Catheterization               97086     97086     1  25.00   0.00           A                                                                                                                                                                                                                N                              
  36. C97128     Electro-Stimulation           97128     97128     9  15.00   0.00           A                                                                                                                                                                                                                N                              
  37. C97260     Spinal Manipulation           97260     97260     9  30.00   0.00           A                                                                                                                                                                                                                N                              
  38. C97540     Phys. Therapy/Life Mgmt. Trng.97540     97540        30.00   0.00           A                                                                                                                                                                                                        0.00    N11                            
  39. L99000     Handling Fee                  99000     99000     5  8.00    0.00           A                                                                                                                                                                                                        0.00    N                              
  40. C99201     Office Visit New Patient FFS  99201     99201     1  30.00   0.00           A                                                                                                                                                                                                                N                              
  41. C99202     Office Visit New Patient EES  99202     99202     1  40.00   0.00           A                                                                                                                                                                                                        30.00   N                              
  42. C99203     Office Visit New Patient DDL  90015     99203     1  50.00   0.00           A                                                                                                                                                                                                                N                              
  43. C99204     Office Visit New Patient CCM  99204     99204     1  65.00   0.00           A                                                                                                                                                                                                                N                              
  44. C99205     Office Visit New Patient CCH  99205     99205        75.00   0.00           A                                                                                                                                                                                                                N                              
  45. C99211     Office Visit Est. Patient MMS 99211     99211     1  25.00   0.00           A                                                                                                                                                                                                        25.00   N                              
  46. C99212     Office Visit Est. Patient FFS 99212     99212     1  40.00   0.00           A                                                                                                                                                                                                        40.00   N                              
  47. C99213     Office Visit Est. Patient EEL 99213     99213     1  60.00   0.00           A                                                                                                                                                                                                        60.00   N                              
  48. C99215     Office Visit Est. Patient CCH 99215     99215        75.00   0.00           A                                                                                                                                                                                                                N                              
  49. C99221     Hospital-Initial E&M DDS      90200     99221     1  0.00    0.00           A                                                                                                                                                                                                                N                              
  50. C99231     Hospital Visit-Subseq. FFS    90250     99231     1  0.00    0.00           A                                                                                                                                                                                                                N                              
  51. C99241     Office Consultation FFS       90600     99241        0.00    0.00           A                                                                                                                                                                                                                N                              
  52. C99242     Office Consultation EES       99242     99242     1  0.00    0.00           A                                                                                                                                                                                                                N                              
  53. C99243     Office Consultation DDL       90610     99243     1  0.00    0.00           A                                                                                                                                                                                                                N                              
  54. C99244     Office Consultation CCM       90620     99244     1  0.00    0.00           A                                                                                                                                                                                                                N                              
  55. C99245     Office Consultation CCH       90630     99245     1  0.00    0.00           A                                                                                                                                                                                                                N                              
  56. C99281     Emergency E&M  FFS            90505     99281     1  100.00  0.00           A                                                                                                                                                                                                                N                              
  57. C99291     Critical Care E&M             90162     99291     1  300.00  0.00           A                                                                                                                                                                                                                N                              
  58. C99392     Well Child Exam 1-4 yrs.      99392     99392     1  50.00   0.00           A                                                                                                                                                                                                                N                              
  59. IAP        Aetna Payment                 AP        AP                                  A                                                                                                                                                                                                        0.00    N                              
  60. IBP        Blue Cross/Blue Shield PaymentBP        BP                                  A                                                                                                                                                                                                        0.00    N                              
  61. SCASH      Cash Payment--Thank You!      CASH      CASH         0.00    0.00           A                                                                                                                                                                                                        0.00    Y                              
  62. PCHECK     Personal Check Payment        CHECK     CHECK        0.00    0.00           A                                                                                                                                                                                                                Y                              
  63. ECOMMENT                                 COMMENT   COMMENT      0.00    0.00           A                                                                                                                                                                                                                N                              
  64. CCONSULT   Initial Consultation          CONSULT   CONSULT      15.00   0.00           A                                                                                                                                                                                                                N                              
  65. OCOPAY10   $10 Co-Payment                COPAY10   COPAY10      10.00   0.00           A                                                                                                                                                                                                                Y                              
  66. OCOPAY2    $2 Co-Payment                 COPAY2    COPAY2       2.00    0.00           A                                                                                                                                                                                                                Y                              
  67. OCOPAY5    $5 Co-Payment                 COPAY5    COPAY5       5.00    0.00           A                                                                                                                                                                                                                Y                              
  68. AFIND      Finder Entry                  FIND      FIND         0.00    0.00           A                                                                                                                                                                                                                N                              
  69. RCRCDPAY   Credit Card Payment           CRCDPAY   CRCDPAY      0.00    0.00           A                                                                                                                                                                                                                Y                              
  70. IDED       NO PAYMENT Applied to DeductibDED       DED                                 A                                                                                                                                                                                                                N                              
  71. IINSPAY    Insurance Payment             INSPAY    INSPAY                              A                                                                                                                                                                                                                N                              
  72. BINSREF    Insurance Payment Refund      INSREF    INSREF                              A                                                                                                                                                                                                                N                              
  73. CJ0210     Prenatal Vitamins             J0210     J0210        20.00   5.00           A                                                                                                                                                                                                                N                              
  74. CJ0490     Benadryl HCL, Up to 50 Mg.    J0490     J0490     9  10.00   5.00           A                                                                                                                                                                                                                N                              
  75. CJ1820     Inj., Insulin, Up to 100 UnitsJ1820     J1820     9  20.00   10.00          A                                                                                                                                                                                                        20.00   N                              
  76. CJ2510     Penicillin, PRCANE, to 600,000J2510     J2510     9  18.00   9.00           A                                                                                                                                                                                                                N                              
  77. IJH        John Hancock Payment          JH        JH                                  A                                                                                                                                                                                                                N                              
  78. CM0025     Medical Emergency             M0025     M0025                               A                                                                                                                                                                                                                N                              
  79. BMCA       Medicare Write-Off            MCA       MCA          -4.53   0.00           A                                                                                                                                                                                                                N                              
  80. IMCP       Medicaid Payment              MCP       MCP                                 A                                                                                                                                                                                                                N                              
  81. BMCWDV5    Medicare Write-Down           MCWDV5    MCWDV5       -9.42   0.00           A                                                                                                                                                                                                                N                              
  82. BMEDADJ    Medicare Adjustment           MEDADJ    MEDADJ                              A                                                                                                                                                                                                        0.00    N                              
  83. CMEDREC    *Medical Records              MEDREC    MEDREC    1  15.00   0.00           A                                                                                                                                                                                                                N                              
  84. IMP        Medicare Payment              MP        MP                                  A                                                                                                                                                                                                        0.00    N                              
  85. IMU        Mutual of Omaha Payment       MU        MU                                  A                                                                                                                                                                                                                N                              
  86. PNOPAY     No Charge Entry               NOPAY     NOPAY        0.00                   A                                                                                                                                                                                                                N                              
  87. APRIORBAL  Patient Write Off from HistoryPRIORBAL  PRIORBAL     0.00    0.00           A                                                                                                                                                                                                                N                              
  88. AUNDERCHG  Adjustment-Undercharge        UNDERCHG  UNDERCHG                            A                                                                                                                                                                                                                N                              
  89. BWROFF     Insurance Write-Off           WROFF     WROFF        -4.00   0.00           A                                                                                                                                                                                                                N                              
  90. MDIAB      Diabetes Screening            99214     82947     36215     99000                                                                                                                                                                                                                                                           
  91. MBPH       Catheterization               99213     87087     97086                                                                                                                                                                                                                                                                     
  92. MLOV                                     99213     97260     97010     97128     XRAY                                                                                                                                                                                                                                                  
  93. CDS        Drug Screen                   DS        DS           40.00   0.00           A                                                                                                                                                                                                                N                              
  94. MTP        Truck Physical                99214     93000     99000     DS                                                                                                                                                                                                                                                              
  95. D005.9     Food Poisoning, Unspecified                                                                                                                                                                                                                                                                                                 
  96. D034.0     Strep Throat                                                                                                                                                                                                                                                                                                                
  97. D052.9     Chicken Pox                                                                                                                                                                                                                                                                                                                 
  98. D110.1     Infected Nail                                                                                                                                                                                                                                                                                                               
  99. D110.4     Athlete's Foot                                                                                                                                                                                                                                                                                                              
  100. D250.01    IDDM Diabetes Mellitus                                                                                                                                                                                                                                                                                                      
  101. D346.9     Headache-Migraine                                                                                                                                                                                                                                                                                                           
  102. D354.0     Carpal Tunnel Syndrome                                                                                                                                                                                                                                                                                                      
  103. D372.03    Pink Eye                                                                                                                                                                                                                                                                                                                    
  104. D372.30    Conjunctivitis                                                                                                                                                                                                                                                                                                              
  105. D373.11    Stye Eye                                                                                                                                                                                                                                                                                                                    
  106. D401.9     Hypertension                                                                                                                                                                                                                                                                                                                
  107. D422.9     Heart Disease                                                                                                                                                                                                                                                                                                               
  108. D454.9     Varicose Veins                                                                                                                                                                                                                                                                                                              
  109. D455.6     Hemorrhoids                                                                                                                                                                                                                                                                                                                 
  110. D461.8     Sinusitis, Acute                                                                                                                                                                                                                                                                                                            
  111. D463.0     Tonsillitis                                                                                                                                                                                                                                                                                                                 
  112. D464.0     Laryngitis, Acute                                                                                                                                                                                                                                                                                                           
  113. D465.9     Upper Respiratory Infection, AC                                                                                                                                                                                                                                                                                             
  114. D486       Pneumonia                                                                                                                                                                                                                                                                                                                   
  115. D487       Influenza                                                                                                                                                                                                                                                                                                                   
  116. D491.0     Chronic Bronchitis                                                                                                                                                                                                                                                                                                          
  117. D492.8     Emphysema                                                                                                                                                                                                                                                                                                                   
  118. D493.9     Allergic Bronchitis                                                                                                                                                                                                                                                                                                         
  119. D503       Lead Miner's Lung                                                                                                                                                                                                                                                                                                           
  120. D531.90    Gastric Ulcer                                                                                                                                                                                                                                                                                                               
  121. D535.5     Gastritis                                                                                                                                                                                                                                                                                                                   
  122. D574.2     Gallstones                                                                                                                                                                                                                                                                                                                  
  123. D692.6     Poison Ivy                                                                                                                                                                                                                                                                                                                  
  124. D692.71    Sunburn                                                                                                                                                                                                                                                                                                                     
  125. D692.9     Dermatitis, Unspecified Cause                                                                                                                                                                                                                                                                                               
  126. D708.9     Hives                                                                                                                                                                                                                                                                                                                       
  127. D715.9     Degenerative Joint Disease                                                                                                                                                                                                                                                                                                  
  128. D716.9     Arthritis, Multiple                                                                                                                                                                                                                                                                                                         
  129. D716.94    Arthritis-Hand                                                                                                                                                                                                                                                                                                              
  130. D719.46    Pain, Knee                                                                                                                                                                                                                                                                                                                  
  131. D719.47    Pain, Ankle                                                                                                                                                                                                                                                                                                                 
  132. D724.2     Low Back Pain                                                                                                                                                                                                                                                                                                               
  133. D726.71    Achilles Tendonitis                                                                                                                                                                                                                                                                                                         
  134. D737.30    Scoliosis, Acquired Postural                                                                                                                                                                                                                                                                                                
  135. D780.4     Vertigo                                                                                                                                                                                                                                                                                                                     
  136. D780.7     Fatigue                                                                                                                                                                                                                                                                                                                     
  137. D782.1     Rash                                                                                                                                                                                                                                                                                                                        
  138. D783.0     Anorexia                                                                                                                                                                                                                                                                                                                    
  139. D785.1     Palpitations                                                                                                                                                                                                                                                                                                                
  140. D785.2     Heart Murmur                                                                                                                                                                                                                                                                                                                
  141. D786.09    Breathing Difficulty                                                                                                                                                                                                                                                                                                        
  142. D786.2     Chronic Cough                                                                                                                                                                                                                                                                                                               
  143. D786.50    Chest Pain                                                                                                                                                                                                                                                                                                                  
  144. D787.0     Nausea                                                                                                                                                                                                                                                                                                                      
  145. D816.00    Fracture, Finger                                                                                                                                                                                                                                                                                                            
  146. D836.1     Tear, Torn Knee Lateral                                                                                                                                                                                                                                                                                                     
  147. D845.00    Sprain Ankle                                                                                                                                                                                                                                                                                                                
  148. D847.2     Back Spasm                                                                                                                                                                                                                                                                                                                  
  149. D959.4     Injury, Hand                                                                                                                                                                                                                                                                                                                
  150. D959.7     Injury, Toe                                                                                                                                                                                                                                                                                                                 
  151. D989.5     Insect Bite                                                                                                                                                                                                                                                                                                                 
  152. D995.3     Allergic Reaction/Allergies                                                                                                                                                                                                                                                                                                 
  153. DV221      Pregnancy                                                                                                                                                                                                                                                                                                                   
  154. DV700      Exam Routine Health (Adult)                                                                                                                                                                                                                                                                                                 
  155. DV2509     Family Planning                                                                                                                                                                                                                                                                                                             
  156. D696.1     Psoriasis                                                                                                                                                                                                                                                                                                                   
  157. D269.2     Vitamin Deficiency                                                                                                                                                                                                                                                                                                          
  158. D372.72    Conjunctival Hemorrhage                                                                                                                                                                                                                                                                                                     
  159. D783.2     Weight Loss                                                                                                                                                                                                                                                                                                                 
  160. D723.1     Neck Pain                                                                                                                                                                                                                                                                                                                   
  161. D078.1     Wart                                                                                                                                                                                                                                                                                                                        
  162. D075.0     Mononucleosis                                                                                                                                                                                                                                                                                                               
  163. D490.0     Bronchitis                                                                                                                                                                                                                                                                                                                  
  164. C99214     Office Visit Est. Patient DDM 99214     99214     1  65.00   0.00           A                                                                                                                                                                                                        50.00   N                              
  165. ACABADDEBT Bad Debt Write-Off            CABADDEBT CABADDEBT                           A                                                                                                                                                                                                                N                              
  166. ACACDISC   Cash Discount                 CACDISC   CACDISC                             A                                                                                                                                                                                                                N                              
  167. ACACHGREV  Charge Reversal               CACHGREV  CACHGREV                            A                                                                                                                                                                                                                N                              
  168. ACACHNGTMT Change in Treatment           CACHNGTMT CACHNGTMT                           A                                                                                                                                                                                                                N                              
  169. ACACOLLECT Sent to Collection Agency     CACOLLECT CACOLLECT                           A                                                                                                                                                                                                                N                              
  170. ACACOLLFEE Collection Fee                CACOLLFEE CACOLLFEE                           A                                                                                                                                                                                                                N                              
  171. ACACORRBAL Correction of Balance         CACORRBAL CACORRBAL                           A                                                                                                                                                                                                                N                              
  172. ACACSYDISC Courtesy Discount             CACSYDISC CACSYDISC                           A                                                                                                                                                                                                                N                              
  173. ACAHPLNDIS Health Plan Discount          CAHPLNDIS CAHPLNDIS                           A                                                                                                                                                                                                                N                              
  174. ACAMEWROFF Medicare/Medicaid Write-Off   CAMEWROFF CAMEWROFF                           A                                                                                                                                                                                                                N                              
  175. ACAOVRCHG  Adjust Overcharge             CAOVRCHG  CAOVRCHG                            A                                                                                                                                                                                                                N                              
  176. BCAPPONON  PPO Non-Allowable             CAPPONON  CAPPONON                            A                                                                                                                                                                                                                N                              
  177. ACAPROFDIS Professional Discount         CAPROFDIS CAPROFDIS                           A                                                                                                                                                                                                                N                              
  178. ACATRANBAL Transfer of Balance           CATRANBAL CATRANBAL                           A                                                                                                                                                                                                                N                              
  179. ACAWROFFBKRWrite-Off Bankruptcy          CAWROFFBKRCAWROFFBKR                          A                                                                                                                                                                                                                N                              
  180. ACAWROFFWELWrite-Off Welfare             CAWROFFWELCAWROFFWEL                          A                                                                                                                                                                                                                N                              
  181. ADACOLLFEE Collection Fee                DACOLLFEE DACOLLFEE                           A                                                                                                                                                                                                                N                              
  182. ADACORRBAL Correction of Balance         DACORRBAL DACORRBAL                           A                                                                                                                                                                                                                N                              
  183. ADAFINCHG  Finance Charge                DAFINCHG  DAFINCHG                            A                                                                                                                                                                                                                N                              
  184. BDAINSCHG  Insurance and Record Charge   DAINSCHG  DAINSCHG                            A                                                                                                                                                                                                                N                              
  185. ADAMISSAPT Missed Appointment Charge     DAMISSAPT DAMISSAPT                           A                                                                                                                                                                                                                N                              
  186. ADANSF     NSF Returned Check Re-Entry   DANSF     DANSF                               A                                                                                                                                                                                                                N                              
  187. ADANSFCHG  NSF Returned Check Charge     DANSFCHG  DANSFCHG                            A                                                                                                                                                                                                                N                              
  188. ADAOVRPMT  Refund for Overpayment        DAOVRPMT  DAOVRPMT                            A                                                                                                                                                                                                                N                              
  189. ADATRANBAL Transfer of Balance           DATRANBAL DATRANBAL                           A                                                                                                                                                                                                                N                              
  190. BMCWRITEDN Medicare Write Down           MCWRITEDN MCWRITEDN                           A                                                                                                                                                                                                                N                              
  191. AWRONGENTRYAdjust Wrong Entry            WRONGENTRYWRONGENTRY                          A                                                                                                                                                                                                                N                              
  192. CXRAY      Routine Spinal X-Ray          XRAY      XRAY         25.00   0.00           A                                                                                                                                                                                                                N                              
  193. HCOPAYCASH Cash Copayment                COPAYCASH COPAYCASH    0.00    0.00           A                                                                                                                                                                                                                Y                              
  194. K85023     Cbc                           85023     85023     5  18.00   0.00           A                                                                                                                                                                                                                N                              
  195. C43220     Esophageal Endoscopy          43220     43220        275.00  0.00           A                                                                                                                                                                                                                N                              
  196. C71040     Contrast X-Ray of Bronchitis  71040     71040        50.00   0.00           A                                                                                                                                                                                                                N                              
  197. C74283     Barium Enema, Therapeutic     74283     74283        110.00  0.00           A                                                                                                                                                                                                                N                              
  198. K82954     Glucose Test                  82954     82954        10.00   0.00           A                                                                                                                                                                                                        0.00    N                              
  199. ICH        Champus Payment               CH        CH                                  A                                                                                                                                                                                                                N                              
  200. BCHWROFF   Champus Write-Off             CHWROFF   CHWROFF      -4.00   0.00           A                                                                                                                                                                                                                N                              
  201. BBPWROFF   Blue Cross/Blue Shield Wr/Off BPWROFF   BPWROFF      -4.00   0.00           A                                                                                                                                                                                                                N                              
  202. ICHV       CHAMPUSVA Payment             CHV       CHV          0.00    0.00           A                                                                                                                                                                                                                N                              
  203. BCHVWROFF  CHAMPUSVA Write-Off           CHVWROFF  CHVWROFF     -4.00   0.00           A                                                                                                                                                                                                                N                              
  204. IFECA      FECA Payment                  FECA      FECA                                A                                                                                                                                                                                                                N                              
  205. BFECAWROFF FECA Write-Off                FECAWROFF FECAWROFF    -4.00   0.00           A                                                                                                                                                                                                                N                              
  206. IIN        Intergroup Payment            IN        IN                                  A                                                                                                                                                                                                                N                              
  207. BINWROFF   Intergroup Write-Off          INWROFF   INWROFF      -4.00   0.00           A                                                                                                                                                                                                                N                              
  208. ICIG       Cigna Payment                 CIG       CIG                                 A                                                                                                                                                                                                                N                              
  209. BCIGWROFF  Cigna Write-Off               CIGWROFF  CIGWROFF     -4.00   0.00           A                                                                                                                                                                                                                N                              
  210. IFHP       FHP Payment                   FHP       FHP                                 A                                                                                                                                                                                                                N                              
  211. BFHPWROFF  FHP Write-Off                 FHPWROFF  FHPWROFF     -4.00   0.00           A                                                                                                                                                                                                                N                              
  212. BAPWROFF   Aetna Write-Off               APWROFF   APWROFF      -4.00   0.00           A                                                                                                                                                                                                                N                              
  213. IHUM       Humana Payment                HUM       HUM          0.00                   A                                                                                                                                                                                                                N                              
  214. BHUMWROFF  Humana Write-Off              HUMWROFF  HUMWROFF     -4.00   0.00           A                                                                                                                                                                                                                N                              
  215. BJHWROFF   John Hancock Write-Off        JHWROFF   JHWROFF      -4.00   0.00           A                                                                                                                                                                                                                N                              
  216. BMUWROFF   Mutual of Omaha Write-Off     MUWROFF   MUWROFF      -4.00   0.00           A                                                                                                                                                                                                                N                              
  217. DV221      Pregnancy                                                                                                                                                                                                                                                                                                                   
  218.                                                                                                                                                                                                                                                                                                                                        
  219.