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Assumption ED Visit MOR CCR D.227 WI 0.8934 DOS 2018 DX 561 409A 723 Calm Information RC CPT Mod-1 Mod-2 Unit Charge 361 29130 1

Assumption ED Visit MOR CCR D.227 WI 0.8934 DOS 2018 DX 561 409A 723 Calm Information RC CPT Mod-1 Mod-2 Unit Charge 361 29130 1 157.50 450 99285 25 654.42 363 90714 1 140.60 940 90471 1 29.99 TOTAL C...

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