{"aaData": [["1", "
Medical Care
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["10", "
Blood Charges
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["A2", "
Prof(Phy) Vst/Skilled Nrs Fac
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["A3", "
Prof(Phy) Visit/Home
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["A4", "
Psychiatric
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["A5", "
Psychiatric/R & B
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["A6", "
Psychotherapy
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["A7", "
Psychiatric/Inpt
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["A8", "
Psychiatric/Outpt
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["A9", "
Rehabilitation
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["AA", "
Rehab/R & B
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["AB", "
Rehab/Inpt
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["11", "
Used DME
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["AC", "
Rehab/Outpt
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["AD", "
Occupational Therapy
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["AE", "
Physical Medicine
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["AF", "
Speech Therapy
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["AG", "
SNC
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["AH", "
SNC/R & B
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["AI", "
Substance Abuse
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["AJ", "
Alcoholism
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["AK", "
Drug Addiction
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["AL", "
Vision (Optometry)
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["12", "
DME Purchase
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["AM", "
Frames
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["AN", "
Routine Exam
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["AO", "
Lenses
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["AQ", "
N/Medically Nec Physical
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["AR", "
Experimental Drug Therapy
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BA", "
Independent Medical Eval
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BB", "
Partial Hosp (Psych)
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BC", "
Day Care (Psych)
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BD", "
Cognitive Therapy
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BE", "
Massage Therapy
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["13", "
Ambulatory SC Facility
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BF", "
Pulmonary Rehab
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BG", "
Cardiac Rehab
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BH", "
Pediatric
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BI", "
Nursery
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BJ", "
Skin
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BK", "
Orthopedic
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BL", "
Cardiac
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BM", "
Lymphatic
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BN", "
Gastrointestinal
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BP", "
Endocrine
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["14", "
Renal Supplies/Home
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BQ", "
Neurology
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BR", "
Eye
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BS", "
Invasive Procedures
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["B1", "
Burn Care
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["B2", "
Brand Name Rx Drug - Formulary
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["B3", "
Brand Name Rx Drug - Non-Formulary
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BT", "
Gynecological
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BU", "
Obstetrical
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BV", "
Obstetrical/Gynecological
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["15", "
Alt. Method Dialysis
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BW", "
Mail Order Prescription Drug: Brand Name
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BX", "
Mail Order Prescription Drug: Generic
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BY", "
Physician Visit - Office: Sick
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["BZ", "
Physician Visit - Office: Well
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["C1", "
Coronary Care
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["CA", "
Private Duty Nursing - Inpatient
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["CB", "
Private Duty Nursing - Home
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["CC", "
Surgical Benefits - Professional (Physician)
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["CD", "
Surgical Benefits - Facility
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["CE", "
Mental Health Provider - Inpatient
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["16", "
CRD Equipment
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["CF", "
Mental Health Provider - Outpatient
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["CG", "
Mental Health Facility - Inpatient
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["CH", "
Mental Health Facility - Outpatient
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["CI", "
Substance Abuse Facility - Inpatient
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["CJ", "
Substance Abuse Facility - Outpatient
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["CK", "
Screening X-ray
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["CL", "
Screening Laboratory
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["CM", "
Mammogram, High Risk Patient
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["CN", "
Mammogram, Low Risk Patient
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["CO", "
Flu Vaccination
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["17", "
Pre-Admission Testing
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["CP", "
Eyewear and Eyewear Accessories
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["CQ", "
Case Management
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["DG", "
Dermatology
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["DM", "
Durable Medical Equipment
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["DS", "
Diabetic Supplies
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["GF", "
Generic Prescription Drug - Formulary
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["GN", "
Generic Prescription Drug - Non-Formulary
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["GY", "
Allergy
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["IC", "
Intensive Care
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["MH", "
Mental Health
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["18", "
DME Rental
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["NI", "
Neonatal Intensive Care
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["ON", "
Oncology
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["PT", "
Physical Therapy
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["PU", "
Pulmonary
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["RN", "
Renal
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["RT", "
Residential Psychiatric Treatment
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["TC", "
Transitional Care
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["TN", "
Transitional Nursery Care
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["UC", "
Urgent Care
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["19", "
Pneumonia Vaccine
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["2", "
Surgical
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["20", "
2nd Surgical Opinion
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["21", "
3rd Surgical Opinion
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["22", "
Social Work
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["23", "
Diagnostic Dental
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["24", "
Periodontics
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["25", "
Restorative
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["26", "
Endodontics
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["27", "
Maxillofacial Prosth.
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["28", "
Adjunctive Dental Serv
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["30", "
Health Benefit Plan Cov
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["3", "
Consultation
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["32", "
Plan Waiting Period
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["33", "
Chiropractic
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["34", "
Chiropractic Office Vst
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["35", "
Dental Care
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["36", "
Dental Crowns
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["37", "
Dental Accident
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["38", "
Orthodontics
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["39", "
Prosthodontics
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["40", "
Oral Surgery
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["41", "
Rout/Preventive Dental
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["4", "
Diagnostic X-Ray
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["42", "
Home Health Care
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["43", "
Home Health RX
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["44", "
Home Health Vst
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["45", "
Hospice
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["46", "
Respite Care
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["47", "
Hospital
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["48", "
Hosp/Inpatient
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["49", "
Hosp/R & B
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["50", "
Hosp/Outpatient
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["51", "
Hosp/Emergency Accident
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["5", "
Diagnostic Lab
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["52", "
Hosp/Emergency Medical
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["53", "
Hosp/Ambulatory Surg
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["54", "
Long Term Care
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["55", "
Major Medical
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["56", "
Med Related Transport
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["57", "
Air Transportation
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["58", "
Cabulance
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["59", "
Licensed Ambulance
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["60", "
General Benefits
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["61", "
In-vitro Fertilization
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["6", "
Radiation Therapy
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["62", "
MRI/CAT Scan
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["63", "
Donor Procedures
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["64", "
Acupuncture
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["65", "
Newborn Care
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["66", "
Pathology
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["67", "
Smoking Cessation
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["68", "
Well Baby Care
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["69", "
Maternity
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["70", "
Transplants
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["71", "
Audiology Exams
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["7", "
Anesthesia
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["72", "
Inhalation Therapy
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["73", "
Diagnostic Medical
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["74", "
Private Duty Nursing
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["75", "
Prosthetic Device
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["76", "
Dialysis
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["77", "
Otological Exam
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["78", "
Chemotherapy
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["79", "
Allergy Testing
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["80", "
Immunizations
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["81", "
Routine Physical
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["8", "
Surgical Assistance
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["82", "
Family Planning
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["83", "
Infertility
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["84", "
Abortion
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["85", "
AIDS
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["86", "
Emergency Services
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["87", "
Cancer
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["88", "
Pharmacy
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["89", "
Free Standing RX Drug
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["90", "
Mail Order RX Drug
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["91", "
Brand Name RX Drug
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["9", "
Other Medical
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["92", "
Generic RX Drug
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["93", "
Podiatry
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["94", "
Podiatry/Office Visits
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["95", "
Podiatry/Nurs Home Vst
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["96", "
Professional (Phy)
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["97", "
Anesthesiologist
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["98", "
Prof(Phy) Visit/Office
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["99", "
Prof(Phy) Visit/Inpt
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["A0", "
Prof(Phy) Visit/Outpt
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"], ["A1", "
Prof(Phy) Visit/NH
\n", "", "
2023-09-19 11:16:11
\n", "
0
\n"]]}