1358
Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91 ARIZONA PPO-PPA DIRECT A0080 1.65 ARIZONA PPO-PPA DIRECT A0090 10.58 ARIZONA PPO-PPA DIRECT A0100 31.49 ARIZONA PPO-PPA DIRECT A0110 11.92 ARIZONA PPO-PPA DIRECT A0120 6.37 ARIZONA PPO-PPA DIRECT A0130 30.68 ARIZONA PPO-PPA DIRECT A0140 451.42 ARIZONA PPO-PPA DIRECT A0160 0.31 ARIZONA PPO-PPA DIRECT A0170 20.15 ARIZONA PPO-PPA DIRECT A0180 3.59 ARIZONA PPO-PPA DIRECT A0190 9.78 ARIZONA PPO-PPA DIRECT A0210 144.06 ARIZONA PPO-PPA DIRECT A0225 336.57 ARIZONA PPO-PPA DIRECT A0380 4.98 ARIZONA PPO-PPA DIRECT A0382 6.84 ARIZONA PPO-PPA DIRECT A0384 34.53 ARIZONA PPO-PPA DIRECT A0390 4.98 ARIZONA PPO-PPA DIRECT A0392 34.53 ARIZONA PPO-PPA DIRECT A0394 16.49 ARIZONA PPO-PPA DIRECT A0396 27.37 ARIZONA PPO-PPA DIRECT A0398 6.84 ARIZONA PPO-PPA DIRECT

85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

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Page 1: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Zip Code: 85004Product Type: PPOCPF Sched ID:Date of Service: 06/22/2015

Service Code Modifier Allowed Amount

Network Name

A0021 5.91 ARIZONA PPO-PPA DIRECT

A0080 1.65 ARIZONA PPO-PPA DIRECT

A0090 10.58 ARIZONA PPO-PPA DIRECT

A0100 31.49 ARIZONA PPO-PPA DIRECT

A0110 11.92 ARIZONA PPO-PPA DIRECT

A0120 6.37 ARIZONA PPO-PPA DIRECT

A0130 30.68 ARIZONA PPO-PPA DIRECT

A0140 451.42 ARIZONA PPO-PPA DIRECT

A0160 0.31 ARIZONA PPO-PPA DIRECT

A0170 20.15 ARIZONA PPO-PPA DIRECT

A0180 3.59 ARIZONA PPO-PPA DIRECT

A0190 9.78 ARIZONA PPO-PPA DIRECT

A0210 144.06 ARIZONA PPO-PPA DIRECT

A0225 336.57 ARIZONA PPO-PPA DIRECT

A0380 4.98 ARIZONA PPO-PPA DIRECT

A0382 6.84 ARIZONA PPO-PPA DIRECT

A0384 34.53 ARIZONA PPO-PPA DIRECT

A0390 4.98 ARIZONA PPO-PPA DIRECT

A0392 34.53 ARIZONA PPO-PPA DIRECT

A0394 16.49 ARIZONA PPO-PPA DIRECT

A0396 27.37 ARIZONA PPO-PPA DIRECT

A0398 6.84 ARIZONA PPO-PPA DIRECT

Page 2: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

A0420 39.03 ARIZONA PPO-PPA DIRECT

A0422 25.51 ARIZONA PPO-PPA DIRECT

A0424 129.96 ARIZONA PPO-PPA DIRECT

A0425 4.98 ARIZONA PPO-PPA DIRECT

A0426 255.39 ARIZONA PPO-PPA DIRECT

A0427 268.45 ARIZONA PPO-PPA DIRECT

A0428 224.59 ARIZONA PPO-PPA DIRECT

A0429 232.99 ARIZONA PPO-PPA DIRECT

A0430 6364.16 ARIZONA PPO-PPA DIRECT

A0431 6039.19 ARIZONA PPO-PPA DIRECT

A0432 531.30 ARIZONA PPO-PPA DIRECT

A0433 689.46 ARIZONA PPO-PPA DIRECT

A0434 1019.99 ARIZONA PPO-PPA DIRECT

A0435 26.93 ARIZONA PPO-PPA DIRECT

A0436 89.13 ARIZONA PPO-PPA DIRECT

A0888 57.72 ARIZONA PPO-PPA DIRECT

A0998 133.64 ARIZONA PPO-PPA DIRECT

A0999 24.34 ARIZONA PPO-PPA DIRECT

A4206 0.31 ARIZONA PPO-PPA DIRECT

A4207 0.33 ARIZONA PPO-PPA DIRECT

A4208 0.31 ARIZONA PPO-PPA DIRECT

A4209 0.31 ARIZONA PPO-PPA DIRECT

A4210 536.90 ARIZONA PPO-PPA DIRECT

A4211 18.71 ARIZONA PPO-PPA DIRECT

A4212 5.29 ARIZONA PPO-PPA DIRECT

A4213 0.62 ARIZONA PPO-PPA DIRECT

A4215 0.32 ARIZONA PPO-PPA DIRECT

Page 3: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

A4216 0.21 ARIZONA PPO-PPA DIRECT

A4217 1.48 ARIZONA PPO-PPA DIRECT

A4218 0.21 ARIZONA PPO-PPA DIRECT

A4220 31.93 ARIZONA PPO-PPA DIRECT

A4221 10.68 ARIZONA PPO-PPA DIRECT

A4222 22.05 ARIZONA PPO-PPA DIRECT

A4223 58.15 ARIZONA PPO-PPA DIRECT

A4230 8.18 ARIZONA PPO-PPA DIRECT

A4231 4.56 ARIZONA PPO-PPA DIRECT

A4232 2.20 ARIZONA PPO-PPA DIRECT

A4233 0.33 ARIZONA PPO-PPA DIRECT

A4234 1.48 ARIZONA PPO-PPA DIRECT

A4235 0.95 ARIZONA PPO-PPA DIRECT

A4236 0.69 ARIZONA PPO-PPA DIRECT

A4244 0.62 ARIZONA PPO-PPA DIRECT

A4245 1.87 ARIZONA PPO-PPA DIRECT

A4246 1.87 ARIZONA PPO-PPA DIRECT

A4247 2.80 ARIZONA PPO-PPA DIRECT

A4248 0.27 ARIZONA PPO-PPA DIRECT

A4250 10.89 ARIZONA PPO-PPA DIRECT

A4252 6.51 ARIZONA PPO-PPA DIRECT

A4253 20.53 ARIZONA PPO-PPA DIRECT

A4255 1.94 ARIZONA PPO-PPA DIRECT

A4256 4.65 ARIZONA PPO-PPA DIRECT

A4257 6.02 ARIZONA PPO-PPA DIRECT

A4258 7.34 ARIZONA PPO-PPA DIRECT

A4259 4.27 ARIZONA PPO-PPA DIRECT

Page 4: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

A4261 60.00 ARIZONA PPO-PPA DIRECT

A4262 0.31 ARIZONA PPO-PPA DIRECT

A4263 24.89 ARIZONA PPO-PPA DIRECT

A4264 736.53 ARIZONA PPO-PPA DIRECT

A4265 1.61 ARIZONA PPO-PPA DIRECT

A4266 24.97 ARIZONA PPO-PPA DIRECT

A4267 0.31 ARIZONA PPO-PPA DIRECT

A4268 1.12 ARIZONA PPO-PPA DIRECT

A4269 0.62 ARIZONA PPO-PPA DIRECT

A4270 10.15 ARIZONA PPO-PPA DIRECT

A4280 2.65 ARIZONA PPO-PPA DIRECT

A4281 18.17 ARIZONA PPO-PPA DIRECT

A4282 3.85 ARIZONA PPO-PPA DIRECT

A4284 10.89 ARIZONA PPO-PPA DIRECT

A4285 3.75 ARIZONA PPO-PPA DIRECT

A4290 177.02 ARIZONA PPO-PPA DIRECT

A4300 28.36 ARIZONA PPO-PPA DIRECT

A4301 74.84 ARIZONA PPO-PPA DIRECT

A4305 8.09 ARIZONA PPO-PPA DIRECT

A4306 11.20 ARIZONA PPO-PPA DIRECT

A4310 3.64 ARIZONA PPO-PPA DIRECT

A4311 7.00 ARIZONA PPO-PPA DIRECT

A4312 8.51 ARIZONA PPO-PPA DIRECT

A4313 8.74 ARIZONA PPO-PPA DIRECT

A4314 11.93 ARIZONA PPO-PPA DIRECT

A4315 12.45 ARIZONA PPO-PPA DIRECT

A4316 13.40 ARIZONA PPO-PPA DIRECT

Page 5: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

A4320 2.52 ARIZONA PPO-PPA DIRECT

A4321 19.08 ARIZONA PPO-PPA DIRECT

A4322 1.44 ARIZONA PPO-PPA DIRECT

A4326 5.09 ARIZONA PPO-PPA DIRECT

A4327 21.04 ARIZONA PPO-PPA DIRECT

A4328 4.93 ARIZONA PPO-PPA DIRECT

A4330 3.38 ARIZONA PPO-PPA DIRECT

A4331 1.50 ARIZONA PPO-PPA DIRECT

A4332 0.06 ARIZONA PPO-PPA DIRECT

A4333 1.04 ARIZONA PPO-PPA DIRECT

A4334 2.32 ARIZONA PPO-PPA DIRECT

A4335 0.23 ARIZONA PPO-PPA DIRECT

A4336 0.68 ARIZONA PPO-PPA DIRECT

A4338 5.79 ARIZONA PPO-PPA DIRECT

A4340 14.98 ARIZONA PPO-PPA DIRECT

A4344 7.55 ARIZONA PPO-PPA DIRECT

A4346 9.24 ARIZONA PPO-PPA DIRECT

A4349 0.95 ARIZONA PPO-PPA DIRECT

A4351 0.86 ARIZONA PPO-PPA DIRECT

A4352 3.03 ARIZONA PPO-PPA DIRECT

A4353 3.30 ARIZONA PPO-PPA DIRECT

A4354 5.57 ARIZONA PPO-PPA DIRECT

A4355 4.21 ARIZONA PPO-PPA DIRECT

A4356 21.52 ARIZONA PPO-PPA DIRECT

A4357 4.58 ARIZONA PPO-PPA DIRECT

A4358 3.13 ARIZONA PPO-PPA DIRECT

A4360 0.23 ARIZONA PPO-PPA DIRECT

Page 6: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

A4361 8.67 ARIZONA PPO-PPA DIRECT

A4362 1.64 ARIZONA PPO-PPA DIRECT

A4363 1.12 ARIZONA PPO-PPA DIRECT

A4364 1.39 ARIZONA PPO-PPA DIRECT

A4366 0.61 ARIZONA PPO-PPA DIRECT

A4367 3.47 ARIZONA PPO-PPA DIRECT

A4368 0.12 ARIZONA PPO-PPA DIRECT

A4369 1.15 ARIZONA PPO-PPA DIRECT

A4371 1.72 ARIZONA PPO-PPA DIRECT

A4372 1.98 ARIZONA PPO-PPA DIRECT

A4373 2.96 ARIZONA PPO-PPA DIRECT

A4375 8.11 ARIZONA PPO-PPA DIRECT

A4376 22.45 ARIZONA PPO-PPA DIRECT

A4377 2.03 ARIZONA PPO-PPA DIRECT

A4378 14.50 ARIZONA PPO-PPA DIRECT

A4379 7.09 ARIZONA PPO-PPA DIRECT

A4380 17.61 ARIZONA PPO-PPA DIRECT

A4381 2.18 ARIZONA PPO-PPA DIRECT

A4382 11.61 ARIZONA PPO-PPA DIRECT

A4383 13.30 ARIZONA PPO-PPA DIRECT

A4384 4.54 ARIZONA PPO-PPA DIRECT

A4385 2.41 ARIZONA PPO-PPA DIRECT

A4387 3.25 ARIZONA PPO-PPA DIRECT

A4388 2.06 ARIZONA PPO-PPA DIRECT

A4389 2.94 ARIZONA PPO-PPA DIRECT

A4390 4.53 ARIZONA PPO-PPA DIRECT

A4391 3.34 ARIZONA PPO-PPA DIRECT

Page 7: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

A4392 3.86 ARIZONA PPO-PPA DIRECT

A4393 4.27 ARIZONA PPO-PPA DIRECT

A4394 1.22 ARIZONA PPO-PPA DIRECT

A4395 0.02 ARIZONA PPO-PPA DIRECT

A4396 19.10 ARIZONA PPO-PPA DIRECT

A4397 2.26 ARIZONA PPO-PPA DIRECT

A4398 6.52 ARIZONA PPO-PPA DIRECT

A4399 5.79 ARIZONA PPO-PPA DIRECT

A4400 23.05 ARIZONA PPO-PPA DIRECT

A4402 0.76 ARIZONA PPO-PPA DIRECT

A4404 0.80 ARIZONA PPO-PPA DIRECT

A4405 1.61 ARIZONA PPO-PPA DIRECT

A4406 2.71 ARIZONA PPO-PPA DIRECT

A4407 4.13 ARIZONA PPO-PPA DIRECT

A4408 4.66 ARIZONA PPO-PPA DIRECT

A4409 2.94 ARIZONA PPO-PPA DIRECT

A4410 4.27 ARIZONA PPO-PPA DIRECT

A4411 2.41 ARIZONA PPO-PPA DIRECT

A4412 1.28 ARIZONA PPO-PPA DIRECT

A4413 2.60 ARIZONA PPO-PPA DIRECT

A4414 2.32 ARIZONA PPO-PPA DIRECT

A4415 2.83 ARIZONA PPO-PPA DIRECT

A4416 1.30 ARIZONA PPO-PPA DIRECT

A4417 1.76 ARIZONA PPO-PPA DIRECT

A4418 0.86 ARIZONA PPO-PPA DIRECT

A4419 0.82 ARIZONA PPO-PPA DIRECT

A4420 1.58 ARIZONA PPO-PPA DIRECT

Page 8: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

A4421 31.61 ARIZONA PPO-PPA DIRECT

A4422 0.06 ARIZONA PPO-PPA DIRECT

A4423 0.88 ARIZONA PPO-PPA DIRECT

A4424 2.25 ARIZONA PPO-PPA DIRECT

A4425 1.69 ARIZONA PPO-PPA DIRECT

A4426 1.29 ARIZONA PPO-PPA DIRECT

A4427 1.32 ARIZONA PPO-PPA DIRECT

A4428 3.08 ARIZONA PPO-PPA DIRECT

A4429 3.90 ARIZONA PPO-PPA DIRECT

A4430 4.02 ARIZONA PPO-PPA DIRECT

A4431 2.94 ARIZONA PPO-PPA DIRECT

A4432 1.70 ARIZONA PPO-PPA DIRECT

A4433 1.58 ARIZONA PPO-PPA DIRECT

A4434 1.77 ARIZONA PPO-PPA DIRECT

A4435 2.73 ARIZONA PPO-PPA DIRECT

A4450 0.05 ARIZONA PPO-PPA DIRECT

A4452 0.19 ARIZONA PPO-PPA DIRECT

A4455 0.68 ARIZONA PPO-PPA DIRECT

A4456 0.12 ARIZONA PPO-PPA DIRECT

A4458 7.57 ARIZONA PPO-PPA DIRECT

A4461 1.55 ARIZONA PPO-PPA DIRECT

A4463 6.28 ARIZONA PPO-PPA DIRECT

A4465 5.60 ARIZONA PPO-PPA DIRECT

A4466 16.43 ARIZONA PPO-PPA DIRECT

A4470 4.04 ARIZONA PPO-PPA DIRECT

A4480 3.11 ARIZONA PPO-PPA DIRECT

A4481 0.18 ARIZONA PPO-PPA DIRECT

Page 9: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

A4483 3.75 ARIZONA PPO-PPA DIRECT

A4490 4.04 ARIZONA PPO-PPA DIRECT

A4495 4.04 ARIZONA PPO-PPA DIRECT

A4500 3.11 ARIZONA PPO-PPA DIRECT

A4510 7.47 ARIZONA PPO-PPA DIRECT

A4520 0.51 ARIZONA PPO-PPA DIRECT

A4550 18.35 ARIZONA PPO-PPA DIRECT

A4554 1.87 ARIZONA PPO-PPA DIRECT

A4556 5.73 ARIZONA PPO-PPA DIRECT

A4557 9.96 ARIZONA PPO-PPA DIRECT

A4558 2.57 ARIZONA PPO-PPA DIRECT

A4559 0.05 ARIZONA PPO-PPA DIRECT

A4561 10.15 ARIZONA PPO-PPA DIRECT

A4562 25.24 ARIZONA PPO-PPA DIRECT

A4565 4.35 ARIZONA PPO-PPA DIRECT

A4566 19.83 ARIZONA PPO-PPA DIRECT

A4570 10.89 ARIZONA PPO-PPA DIRECT

A4580 30.14 ARIZONA PPO-PPA DIRECT

A4590 24.26 ARIZONA PPO-PPA DIRECT

A4595 13.59 ARIZONA PPO-PPA DIRECT

A4600 175.22 ARIZONA PPO-PPA DIRECT

A4604 27.16 ARIZONA PPO-PPA DIRECT

A4605 7.74 ARIZONA PPO-PPA DIRECT

A4606 44.27 ARIZONA PPO-PPA DIRECT

A4608 23.65 ARIZONA PPO-PPA DIRECT

A4611 110.74 ARIZONA PPO-PPA DIRECT

A4612 45.10 ARIZONA PPO-PPA DIRECT

Page 10: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

A4613 81.19 ARIZONA PPO-PPA DIRECT

A4614 11.22 ARIZONA PPO-PPA DIRECT

A4615 0.34 ARIZONA PPO-PPA DIRECT

A4616 0.03 ARIZONA PPO-PPA DIRECT

A4617 1.46 ARIZONA PPO-PPA DIRECT

A4618 4.20 ARIZONA PPO-PPA DIRECT

A4619 0.88 ARIZONA PPO-PPA DIRECT

A4620 0.30 ARIZONA PPO-PPA DIRECT

A4623 3.09 ARIZONA PPO-PPA DIRECT

A4624 1.24 ARIZONA PPO-PPA DIRECT

A4625 3.27 ARIZONA PPO-PPA DIRECT

A4626 1.51 ARIZONA PPO-PPA DIRECT

A4627 10.58 ARIZONA PPO-PPA DIRECT

A4628 1.77 ARIZONA PPO-PPA DIRECT

A4629 2.19 ARIZONA PPO-PPA DIRECT

A4630 2.95 ARIZONA PPO-PPA DIRECT

A4633 19.36 ARIZONA PPO-PPA DIRECT

A4634 31.83 ARIZONA PPO-PPA DIRECT

A4635 2.42 ARIZONA PPO-PPA DIRECT

A4636 1.72 ARIZONA PPO-PPA DIRECT

A4637 0.87 ARIZONA PPO-PPA DIRECT

A4639 161.75 ARIZONA PPO-PPA DIRECT

A4640 29.87 ARIZONA PPO-PPA DIRECT

A4641 131.05 ARIZONA PPO-PPA DIRECT

A4642 50.36 ARIZONA PPO-PPA DIRECT

A4648 131.72 ARIZONA PPO-PPA DIRECT

A4649 81.66 ARIZONA PPO-PPA DIRECT

Page 11: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

A4651 5.80 ARIZONA PPO-PPA DIRECT

A4652 12.96 ARIZONA PPO-PPA DIRECT

A4657 6.32 ARIZONA PPO-PPA DIRECT

A4660 8.09 ARIZONA PPO-PPA DIRECT

A4663 15.86 ARIZONA PPO-PPA DIRECT

A4670 40.44 ARIZONA PPO-PPA DIRECT

A4680 41.06 ARIZONA PPO-PPA DIRECT

A4690 406.87 ARIZONA PPO-PPA DIRECT

A4706 2.18 ARIZONA PPO-PPA DIRECT

A4707 24.91 ARIZONA PPO-PPA DIRECT

A4709 17.04 ARIZONA PPO-PPA DIRECT

A4720 9.19 ARIZONA PPO-PPA DIRECT

A4736 18.75 ARIZONA PPO-PPA DIRECT

A4750 7.78 ARIZONA PPO-PPA DIRECT

A4755 13.55 ARIZONA PPO-PPA DIRECT

A4760 60.43 ARIZONA PPO-PPA DIRECT

A4770 5.95 ARIZONA PPO-PPA DIRECT

A4772 16.49 ARIZONA PPO-PPA DIRECT

A4773 10.27 ARIZONA PPO-PPA DIRECT

A4774 4.50 ARIZONA PPO-PPA DIRECT

A4802 3.11 ARIZONA PPO-PPA DIRECT

A4860 4.83 ARIZONA PPO-PPA DIRECT

A4911 11.39 ARIZONA PPO-PPA DIRECT

A4913 1.95 ARIZONA PPO-PPA DIRECT

A4927 2.49 ARIZONA PPO-PPA DIRECT

A4928 1.70 ARIZONA PPO-PPA DIRECT

A4929 0.31 ARIZONA PPO-PPA DIRECT

Page 12: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

A4930 0.62 ARIZONA PPO-PPA DIRECT

A4931 3.75 ARIZONA PPO-PPA DIRECT

A5051 0.98 ARIZONA PPO-PPA DIRECT

A5052 0.70 ARIZONA PPO-PPA DIRECT

A5053 0.82 ARIZONA PPO-PPA DIRECT

A5054 0.85 ARIZONA PPO-PPA DIRECT

A5055 0.68 ARIZONA PPO-PPA DIRECT

A5056 2.20 ARIZONA PPO-PPA DIRECT

A5057 4.53 ARIZONA PPO-PPA DIRECT

A5061 1.67 ARIZONA PPO-PPA DIRECT

A5062 1.05 ARIZONA PPO-PPA DIRECT

A5063 1.28 ARIZONA PPO-PPA DIRECT

A5071 2.84 ARIZONA PPO-PPA DIRECT

A5072 1.67 ARIZONA PPO-PPA DIRECT

A5073 1.50 ARIZONA PPO-PPA DIRECT

A5081 1.56 ARIZONA PPO-PPA DIRECT

A5082 5.61 ARIZONA PPO-PPA DIRECT

A5083 0.30 ARIZONA PPO-PPA DIRECT

A5093 0.92 ARIZONA PPO-PPA DIRECT

A5102 10.65 ARIZONA PPO-PPA DIRECT

A5105 19.23 ARIZONA PPO-PPA DIRECT

A5112 16.33 ARIZONA PPO-PPA DIRECT

A5113 2.23 ARIZONA PPO-PPA DIRECT

A5114 4.23 ARIZONA PPO-PPA DIRECT

A5120 0.12 ARIZONA PPO-PPA DIRECT

A5121 3.52 ARIZONA PPO-PPA DIRECT

A5122 6.06 ARIZONA PPO-PPA DIRECT

Page 13: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

A5126 0.62 ARIZONA PPO-PPA DIRECT

A5131 7.48 ARIZONA PPO-PPA DIRECT

A5200 5.34 ARIZONA PPO-PPA DIRECT

A5500 31.76 ARIZONA PPO-PPA DIRECT

A5501 95.26 ARIZONA PPO-PPA DIRECT

A5503 15.56 ARIZONA PPO-PPA DIRECT

A5504 15.56 ARIZONA PPO-PPA DIRECT

A5505 15.56 ARIZONA PPO-PPA DIRECT

A5506 15.56 ARIZONA PPO-PPA DIRECT

A5507 15.56 ARIZONA PPO-PPA DIRECT

A5508 25.66 ARIZONA PPO-PPA DIRECT

A5510 20.56 ARIZONA PPO-PPA DIRECT

A5512 12.96 ARIZONA PPO-PPA DIRECT

A5513 19.33 ARIZONA PPO-PPA DIRECT

A6010 14.61 ARIZONA PPO-PPA DIRECT

A6011 1.08 ARIZONA PPO-PPA DIRECT

A6021 9.92 ARIZONA PPO-PPA DIRECT

A6022 9.92 ARIZONA PPO-PPA DIRECT

A6023 89.78 ARIZONA PPO-PPA DIRECT

A6024 2.92 ARIZONA PPO-PPA DIRECT

A6025 15.24 ARIZONA PPO-PPA DIRECT

A6154 6.79 ARIZONA PPO-PPA DIRECT

A6196 3.47 ARIZONA PPO-PPA DIRECT

A6197 7.75 ARIZONA PPO-PPA DIRECT

A6198 13.72 ARIZONA PPO-PPA DIRECT

A6199 2.50 ARIZONA PPO-PPA DIRECT

A6203 1.59 ARIZONA PPO-PPA DIRECT

Page 14: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

A6204 2.94 ARIZONA PPO-PPA DIRECT

A6205 3.28 ARIZONA PPO-PPA DIRECT

A6206 2.80 ARIZONA PPO-PPA DIRECT

A6207 3.46 ARIZONA PPO-PPA DIRECT

A6208 5.63 ARIZONA PPO-PPA DIRECT

A6209 3.53 ARIZONA PPO-PPA DIRECT

A6210 9.40 ARIZONA PPO-PPA DIRECT

A6211 13.86 ARIZONA PPO-PPA DIRECT

A6212 4.58 ARIZONA PPO-PPA DIRECT

A6213 13.38 ARIZONA PPO-PPA DIRECT

A6214 4.86 ARIZONA PPO-PPA DIRECT

A6215 4.28 ARIZONA PPO-PPA DIRECT

A6216 0.02 ARIZONA PPO-PPA DIRECT

A6217 2.22 ARIZONA PPO-PPA DIRECT

A6218 0.31 ARIZONA PPO-PPA DIRECT

A6219 0.45 ARIZONA PPO-PPA DIRECT

A6220 1.22 ARIZONA PPO-PPA DIRECT

A6221 2.40 ARIZONA PPO-PPA DIRECT

A6222 1.01 ARIZONA PPO-PPA DIRECT

A6223 1.15 ARIZONA PPO-PPA DIRECT

A6224 1.71 ARIZONA PPO-PPA DIRECT

A6228 1.24 ARIZONA PPO-PPA DIRECT

A6229 1.71 ARIZONA PPO-PPA DIRECT

A6230 1.87 ARIZONA PPO-PPA DIRECT

A6231 2.21 ARIZONA PPO-PPA DIRECT

A6232 3.24 ARIZONA PPO-PPA DIRECT

A6233 9.05 ARIZONA PPO-PPA DIRECT

Page 15: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

A6234 3.09 ARIZONA PPO-PPA DIRECT

A6235 7.93 ARIZONA PPO-PPA DIRECT

A6236 12.86 ARIZONA PPO-PPA DIRECT

A6237 3.74 ARIZONA PPO-PPA DIRECT

A6238 10.76 ARIZONA PPO-PPA DIRECT

A6240 5.78 ARIZONA PPO-PPA DIRECT

A6241 1.21 ARIZONA PPO-PPA DIRECT

A6242 2.86 ARIZONA PPO-PPA DIRECT

A6243 5.81 ARIZONA PPO-PPA DIRECT

A6244 18.53 ARIZONA PPO-PPA DIRECT

A6245 3.43 ARIZONA PPO-PPA DIRECT

A6246 4.69 ARIZONA PPO-PPA DIRECT

A6247 11.22 ARIZONA PPO-PPA DIRECT

A6248 7.67 ARIZONA PPO-PPA DIRECT

A6250 21.42 ARIZONA PPO-PPA DIRECT

A6251 0.94 ARIZONA PPO-PPA DIRECT

A6252 1.54 ARIZONA PPO-PPA DIRECT

A6253 2.99 ARIZONA PPO-PPA DIRECT

A6254 0.57 ARIZONA PPO-PPA DIRECT

A6255 1.43 ARIZONA PPO-PPA DIRECT

A6256 4.32 ARIZONA PPO-PPA DIRECT

A6257 0.73 ARIZONA PPO-PPA DIRECT

A6258 2.04 ARIZONA PPO-PPA DIRECT

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A6266 0.91 ARIZONA PPO-PPA DIRECT

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A6502 95.84 ARIZONA PPO-PPA DIRECT

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A7000 3.88 ARIZONA PPO-PPA DIRECT

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A7032 16.48 ARIZONA PPO-PPA DIRECT

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A7524 36.52 ARIZONA PPO-PPA DIRECT

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A9501 54.94 ARIZONA PPO-PPA DIRECT

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A9552 0.00 ARIZONA PPO-PPA DIRECT

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A9600 367.68 ARIZONA PPO-PPA DIRECT

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B4159 0.93 ARIZONA PPO-PPA DIRECT

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B9999 18.84 ARIZONA PPO-PPA DIRECT

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C1888 245.47 ARIZONA PPO-PPA DIRECT

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C9356 62.44 ARIZONA PPO-PPA DIRECT

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D0250 17.42 ARIZONA PPO-PPA DIRECT

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D0475 32.04 ARIZONA PPO-PPA DIRECT

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D2920 33.91 ARIZONA PPO-PPA DIRECT

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D3310 233.92 ARIZONA PPO-PPA DIRECT

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D4240 261.30 ARIZONA PPO-PPA DIRECT

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D5212 493.04 ARIZONA PPO-PPA DIRECT

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D5741 105.45 ARIZONA PPO-PPA DIRECT

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D5955 2079.48 ARIZONA PPO-PPA DIRECT

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D6069 476.86 ARIZONA PPO-PPA DIRECT

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D6252 338.44 ARIZONA PPO-PPA DIRECT

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D6750 410.92 ARIZONA PPO-PPA DIRECT

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D7261 229.26 ARIZONA PPO-PPA DIRECT

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D7441 642.04 ARIZONA PPO-PPA DIRECT

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D7680 2816.08 ARIZONA PPO-PPA DIRECT

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D7876 2296.29 ARIZONA PPO-PPA DIRECT

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D7991 1375.84 ARIZONA PPO-PPA DIRECT

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L1902 35.72 ARIZONA PPO-PPA DIRECT

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L2037 745.34 ARIZONA PPO-PPA DIRECT

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L2040 79.45 ARIZONA PPO-PPA DIRECT

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L2232 41.84 ARIZONA PPO-PPA DIRECT

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L2430 61.29 ARIZONA PPO-PPA DIRECT

L2492 45.63 ARIZONA PPO-PPA DIRECT

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L2760 27.19 ARIZONA PPO-PPA DIRECT

L2768 55.70 ARIZONA PPO-PPA DIRECT

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L3100 18.49 ARIZONA PPO-PPA DIRECT

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L3251 28.31 ARIZONA PPO-PPA DIRECT

L3252 112.29 ARIZONA PPO-PPA DIRECT

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L3460 14.68 ARIZONA PPO-PPA DIRECT

L3465 25.02 ARIZONA PPO-PPA DIRECT

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L3674 459.92 ARIZONA PPO-PPA DIRECT

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L3675 68.28 ARIZONA PPO-PPA DIRECT

L3677 83.05 ARIZONA PPO-PPA DIRECT

L3702 112.36 ARIZONA PPO-PPA DIRECT

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L3720 286.41 ARIZONA PPO-PPA DIRECT

L3730 394.74 ARIZONA PPO-PPA DIRECT

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L3762 41.84 ARIZONA PPO-PPA DIRECT

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L3766 528.31 ARIZONA PPO-PPA DIRECT

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L3901 703.70 ARIZONA PPO-PPA DIRECT

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L3916 206.83 ARIZONA PPO-PPA DIRECT

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L3982 163.47 ARIZONA PPO-PPA DIRECT

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L4387 67.79 ARIZONA PPO-PPA DIRECT

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L5341 2409.44 ARIZONA PPO-PPA DIRECT

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L5618 134.08 ARIZONA PPO-PPA DIRECT

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L6550 1817.94 ARIZONA PPO-PPA DIRECT

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T5999 11.25 ARIZONA PPO-PPA DIRECT

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V2205 27.87 ARIZONA PPO-PPA DIRECT

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V5259 1900.00 ARIZONA PPO-PPA DIRECT

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27258 1010.29 ARIZONA PPO-PPA DIRECT

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27328 375.19 ARIZONA PPO-PPA DIRECT

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27390 393.11 ARIZONA PPO-PPA DIRECT

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27438 762.28 ARIZONA PPO-PPA DIRECT

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27497 492.70 ARIZONA PPO-PPA DIRECT

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27552 560.26 ARIZONA PPO-PPA DIRECT

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27614 374.98 ARIZONA PPO-PPA DIRECT

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27665 387.60 ARIZONA PPO-PPA DIRECT

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27726 812.26 ARIZONA PPO-PPA DIRECT

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27814 710.45 ARIZONA PPO-PPA DIRECT

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28062 395.68 ARIZONA PPO-PPA DIRECT

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29445 131.81 ARIZONA PPO-PPA DIRECT

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29819 535.13 ARIZONA PPO-PPA DIRECT

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30801 197.24 ARIZONA PPO-PPA DIRECT

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35363 1662.68 ARIZONA PPO-PPA DIRECT

35371 815.04 ARIZONA PPO-PPA DIRECT

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35372 977.48 ARIZONA PPO-PPA DIRECT

35390 158.33 ARIZONA PPO-PPA DIRECT

35400 149.67 ARIZONA PPO-PPA DIRECT

35450 503.06 ARIZONA PPO-PPA DIRECT

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35460 306.47 ARIZONA PPO-PPA DIRECT

35471 521.38 ARIZONA PPO-PPA DIRECT

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35501 1481.33 ARIZONA PPO-PPA DIRECT

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35510 1222.24 ARIZONA PPO-PPA DIRECT

35511 1161.69 ARIZONA PPO-PPA DIRECT

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35525 1104.49 ARIZONA PPO-PPA DIRECT

35526 1677.95 ARIZONA PPO-PPA DIRECT

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35531 1974.20 ARIZONA PPO-PPA DIRECT

35533 1530.27 ARIZONA PPO-PPA DIRECT

35535 2138.04 ARIZONA PPO-PPA DIRECT

35536 1708.72 ARIZONA PPO-PPA DIRECT

35537 2090.84 ARIZONA PPO-PPA DIRECT

35538 2334.73 ARIZONA PPO-PPA DIRECT

35539 2189.93 ARIZONA PPO-PPA DIRECT

35540 2441.64 ARIZONA PPO-PPA DIRECT

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35626 1533.41 ARIZONA PPO-PPA DIRECT

35631 1833.80 ARIZONA PPO-PPA DIRECT

35632 2029.95 ARIZONA PPO-PPA DIRECT

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35650 1054.43 ARIZONA PPO-PPA DIRECT

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35694 1016.95 ARIZONA PPO-PPA DIRECT

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36011 153.38 ARIZONA PPO-PPA DIRECT

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36248 49.76 ARIZONA PPO-PPA DIRECT

36251 311.83 ARIZONA PPO-PPA DIRECT

36252 406.15 ARIZONA PPO-PPA DIRECT

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36476 380.23 ARIZONA PPO-PPA DIRECT

36478 1608.94 ARIZONA PPO-PPA DIRECT

36479 386.54 ARIZONA PPO-PPA DIRECT

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36576 178.06 ARIZONA PPO-PPA DIRECT

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36819 765.96 ARIZONA PPO-PPA DIRECT

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37191 266.37 ARIZONA PPO-PPA DIRECT

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37232 234.68 ARIZONA PPO-PPA DIRECT

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37650 483.85 ARIZONA PPO-PPA DIRECT

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50120 910.05 ARIZONA PPO-PPA DIRECT

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50688 79.61 ARIZONA PPO-PPA DIRECT

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50930 1042.05 ARIZONA PPO-PPA DIRECT

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51725 238.69 ARIZONA PPO-PPA DIRECT

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52315 267.47 ARIZONA PPO-PPA DIRECT

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55680 332.26 ARIZONA PPO-PPA DIRECT

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57556 518.85 ARIZONA PPO-PPA DIRECT

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58292 1220.16 ARIZONA PPO-PPA DIRECT

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63085 1683.06 ARIZONA PPO-PPA DIRECT

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75731 TC 323.96 ARIZONA PPO-PPA DIRECT

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75801 TC 206.43 ARIZONA PPO-PPA DIRECT

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75827 TC 305.40 ARIZONA PPO-PPA DIRECT

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75885 TC 306.88 ARIZONA PPO-PPA DIRECT

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75902 TC 81.58 ARIZONA PPO-PPA DIRECT

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75959 TC 0.00 ARIZONA PPO-PPA DIRECT

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75984 TC 78.19 ARIZONA PPO-PPA DIRECT

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76102 TC 174.74 ARIZONA PPO-PPA DIRECT

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76498 0.00 ARIZONA PPO-PPA DIRECT

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76870 110.63 ARIZONA PPO-PPA DIRECT

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77081 26 10.19 ARIZONA PPO-PPA DIRECT

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77293 26 109.45 ARIZONA PPO-PPA DIRECT

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77411 TC 149.85 ARIZONA PPO-PPA DIRECT

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77423 TC 185.11 ARIZONA PPO-PPA DIRECT

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78232 26 22.27 ARIZONA PPO-PPA DIRECT

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78272 26 12.47 ARIZONA PPO-PPA DIRECT

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78315 26 48.70 ARIZONA PPO-PPA DIRECT

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78452 26 82.44 ARIZONA PPO-PPA DIRECT

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78469 26 46.03 ARIZONA PPO-PPA DIRECT

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78499 26 0.00 ARIZONA PPO-PPA DIRECT

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80173 TC 12.25 ARIZONA PPO-PPA DIRECT

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80184 TC 9.60 ARIZONA PPO-PPA DIRECT

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80197 TC 11.44 ARIZONA PPO-PPA DIRECT

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80301 TC 0.00 ARIZONA PPO-PPA DIRECT

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80325 TC 0.00 ARIZONA PPO-PPA DIRECT

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80334 TC 0.00 ARIZONA PPO-PPA DIRECT

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80343 TC 0.00 ARIZONA PPO-PPA DIRECT

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80352 TC 0.00 ARIZONA PPO-PPA DIRECT

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80361 TC 0.00 ARIZONA PPO-PPA DIRECT

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80370 TC 0.00 ARIZONA PPO-PPA DIRECT

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80402 TC 64.74 ARIZONA PPO-PPA DIRECT

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80418 TC 422.78 ARIZONA PPO-PPA DIRECT

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80435 TC 71.89 ARIZONA PPO-PPA DIRECT

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81003 26 1.84 ARIZONA PPO-PPA DIRECT

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81201 TC 0.00 ARIZONA PPO-PPA DIRECT

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81211 TC 0.00 ARIZONA PPO-PPA DIRECT

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81222 TC 0.00 ARIZONA PPO-PPA DIRECT

81222 26 0.00 ARIZONA PPO-PPA DIRECT

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81240 TC 0.00 ARIZONA PPO-PPA DIRECT

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81252 TC 0.00 ARIZONA PPO-PPA DIRECT

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81263 TC 0.00 ARIZONA PPO-PPA DIRECT

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81281 TC 0.00 ARIZONA PPO-PPA DIRECT

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81296 0.00 ARIZONA PPO-PPA DIRECT

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81310 0.00 ARIZONA PPO-PPA DIRECT

81310 TC 0.00 ARIZONA PPO-PPA DIRECT

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81323 0.00 ARIZONA PPO-PPA DIRECT

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81342 0.00 ARIZONA PPO-PPA DIRECT

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81376 0.00 ARIZONA PPO-PPA DIRECT

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81401 0.00 ARIZONA PPO-PPA DIRECT

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81411 0.00 ARIZONA PPO-PPA DIRECT

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81431 0.00 ARIZONA PPO-PPA DIRECT

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81470 0.00 ARIZONA PPO-PPA DIRECT

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81509 0.00 ARIZONA PPO-PPA DIRECT

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82010 6.94 ARIZONA PPO-PPA DIRECT

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82024 26 32.27 ARIZONA PPO-PPA DIRECT

82030 21.65 ARIZONA PPO-PPA DIRECT

82030 TC 21.65 ARIZONA PPO-PPA DIRECT

82030 26 21.65 ARIZONA PPO-PPA DIRECT

82040 4.08 ARIZONA PPO-PPA DIRECT

82040 TC 4.08 ARIZONA PPO-PPA DIRECT

82040 26 4.08 ARIZONA PPO-PPA DIRECT

82042 4.29 ARIZONA PPO-PPA DIRECT

82042 TC 4.29 ARIZONA PPO-PPA DIRECT

82042 26 4.29 ARIZONA PPO-PPA DIRECT

82043 4.90 ARIZONA PPO-PPA DIRECT

82043 TC 4.90 ARIZONA PPO-PPA DIRECT

82043 26 4.90 ARIZONA PPO-PPA DIRECT

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82044 3.88 ARIZONA PPO-PPA DIRECT

82044 TC 3.88 ARIZONA PPO-PPA DIRECT

82044 26 3.88 ARIZONA PPO-PPA DIRECT

82045 28.39 ARIZONA PPO-PPA DIRECT

82045 TC 28.39 ARIZONA PPO-PPA DIRECT

82045 26 28.39 ARIZONA PPO-PPA DIRECT

82055 8.99 ARIZONA PPO-PPA DIRECT

82055 TC 8.99 ARIZONA PPO-PPA DIRECT

82055 26 8.99 ARIZONA PPO-PPA DIRECT

82075 10.01 ARIZONA PPO-PPA DIRECT

82075 TC 10.01 ARIZONA PPO-PPA DIRECT

82075 26 10.01 ARIZONA PPO-PPA DIRECT

82085 8.17 ARIZONA PPO-PPA DIRECT

82085 TC 8.17 ARIZONA PPO-PPA DIRECT

82085 26 8.17 ARIZONA PPO-PPA DIRECT

82088 34.11 ARIZONA PPO-PPA DIRECT

82088 TC 34.11 ARIZONA PPO-PPA DIRECT

82088 26 34.11 ARIZONA PPO-PPA DIRECT

82101 25.12 ARIZONA PPO-PPA DIRECT

82101 TC 25.12 ARIZONA PPO-PPA DIRECT

82101 26 25.12 ARIZONA PPO-PPA DIRECT

82103 11.23 ARIZONA PPO-PPA DIRECT

82103 TC 11.23 ARIZONA PPO-PPA DIRECT

82103 26 11.23 ARIZONA PPO-PPA DIRECT

82104 12.05 ARIZONA PPO-PPA DIRECT

82104 TC 12.05 ARIZONA PPO-PPA DIRECT

82104 26 12.05 ARIZONA PPO-PPA DIRECT

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82105 14.09 ARIZONA PPO-PPA DIRECT

82105 TC 14.09 ARIZONA PPO-PPA DIRECT

82105 26 14.09 ARIZONA PPO-PPA DIRECT

82106 14.09 ARIZONA PPO-PPA DIRECT

82106 TC 14.09 ARIZONA PPO-PPA DIRECT

82106 26 14.09 ARIZONA PPO-PPA DIRECT

82107 53.92 ARIZONA PPO-PPA DIRECT

82107 TC 53.92 ARIZONA PPO-PPA DIRECT

82107 26 53.92 ARIZONA PPO-PPA DIRECT

82108 21.24 ARIZONA PPO-PPA DIRECT

82108 TC 21.24 ARIZONA PPO-PPA DIRECT

82108 26 21.24 ARIZONA PPO-PPA DIRECT

82120 3.06 ARIZONA PPO-PPA DIRECT

82120 TC 3.06 ARIZONA PPO-PPA DIRECT

82120 26 3.06 ARIZONA PPO-PPA DIRECT

82127 11.64 ARIZONA PPO-PPA DIRECT

82127 TC 11.64 ARIZONA PPO-PPA DIRECT

82127 26 11.64 ARIZONA PPO-PPA DIRECT

82128 11.64 ARIZONA PPO-PPA DIRECT

82128 TC 11.64 ARIZONA PPO-PPA DIRECT

82128 26 11.64 ARIZONA PPO-PPA DIRECT

82131 14.09 ARIZONA PPO-PPA DIRECT

82131 TC 14.09 ARIZONA PPO-PPA DIRECT

82131 26 14.09 ARIZONA PPO-PPA DIRECT

82135 13.89 ARIZONA PPO-PPA DIRECT

82135 TC 13.89 ARIZONA PPO-PPA DIRECT

82135 26 13.89 ARIZONA PPO-PPA DIRECT

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82136 14.09 ARIZONA PPO-PPA DIRECT

82136 TC 14.09 ARIZONA PPO-PPA DIRECT

82136 26 14.09 ARIZONA PPO-PPA DIRECT

82139 14.09 ARIZONA PPO-PPA DIRECT

82139 TC 14.09 ARIZONA PPO-PPA DIRECT

82139 26 14.09 ARIZONA PPO-PPA DIRECT

82140 12.25 ARIZONA PPO-PPA DIRECT

82140 TC 12.25 ARIZONA PPO-PPA DIRECT

82140 26 12.25 ARIZONA PPO-PPA DIRECT

82143 5.72 ARIZONA PPO-PPA DIRECT

82143 TC 5.72 ARIZONA PPO-PPA DIRECT

82143 26 5.72 ARIZONA PPO-PPA DIRECT

82145 13.07 ARIZONA PPO-PPA DIRECT

82145 TC 13.07 ARIZONA PPO-PPA DIRECT

82145 26 13.07 ARIZONA PPO-PPA DIRECT

82150 5.51 ARIZONA PPO-PPA DIRECT

82150 TC 5.51 ARIZONA PPO-PPA DIRECT

82150 26 5.51 ARIZONA PPO-PPA DIRECT

82154 24.10 ARIZONA PPO-PPA DIRECT

82154 TC 24.10 ARIZONA PPO-PPA DIRECT

82154 26 24.10 ARIZONA PPO-PPA DIRECT

82157 24.51 ARIZONA PPO-PPA DIRECT

82157 TC 24.51 ARIZONA PPO-PPA DIRECT

82157 26 24.51 ARIZONA PPO-PPA DIRECT

82160 21.04 ARIZONA PPO-PPA DIRECT

82160 TC 21.04 ARIZONA PPO-PPA DIRECT

82160 26 21.04 ARIZONA PPO-PPA DIRECT

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82163 17.16 ARIZONA PPO-PPA DIRECT

82163 TC 17.16 ARIZONA PPO-PPA DIRECT

82163 26 17.16 ARIZONA PPO-PPA DIRECT

82164 12.25 ARIZONA PPO-PPA DIRECT

82164 TC 12.25 ARIZONA PPO-PPA DIRECT

82164 26 12.25 ARIZONA PPO-PPA DIRECT

82172 13.07 ARIZONA PPO-PPA DIRECT

82172 TC 13.07 ARIZONA PPO-PPA DIRECT

82172 26 13.07 ARIZONA PPO-PPA DIRECT

82175 15.93 ARIZONA PPO-PPA DIRECT

82175 TC 15.93 ARIZONA PPO-PPA DIRECT

82175 26 15.93 ARIZONA PPO-PPA DIRECT

82180 8.37 ARIZONA PPO-PPA DIRECT

82180 TC 8.37 ARIZONA PPO-PPA DIRECT

82180 26 8.37 ARIZONA PPO-PPA DIRECT

82190 12.46 ARIZONA PPO-PPA DIRECT

82190 TC 12.46 ARIZONA PPO-PPA DIRECT

82190 26 12.46 ARIZONA PPO-PPA DIRECT

82205 9.60 ARIZONA PPO-PPA DIRECT

82205 TC 9.60 ARIZONA PPO-PPA DIRECT

82205 26 9.60 ARIZONA PPO-PPA DIRECT

82232 13.48 ARIZONA PPO-PPA DIRECT

82232 TC 13.48 ARIZONA PPO-PPA DIRECT

82232 26 13.48 ARIZONA PPO-PPA DIRECT

82239 14.30 ARIZONA PPO-PPA DIRECT

82239 TC 14.30 ARIZONA PPO-PPA DIRECT

82239 26 14.30 ARIZONA PPO-PPA DIRECT

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82240 22.26 ARIZONA PPO-PPA DIRECT

82240 TC 22.26 ARIZONA PPO-PPA DIRECT

82240 26 22.26 ARIZONA PPO-PPA DIRECT

82247 4.29 ARIZONA PPO-PPA DIRECT

82247 TC 4.29 ARIZONA PPO-PPA DIRECT

82247 26 4.29 ARIZONA PPO-PPA DIRECT

82248 4.29 ARIZONA PPO-PPA DIRECT

82248 TC 4.29 ARIZONA PPO-PPA DIRECT

82248 26 4.29 ARIZONA PPO-PPA DIRECT

82252 3.88 ARIZONA PPO-PPA DIRECT

82252 TC 3.88 ARIZONA PPO-PPA DIRECT

82252 26 3.88 ARIZONA PPO-PPA DIRECT

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82261 TC 14.09 ARIZONA PPO-PPA DIRECT

82261 26 14.09 ARIZONA PPO-PPA DIRECT

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82270 TC 2.66 ARIZONA PPO-PPA DIRECT

82270 26 2.66 ARIZONA PPO-PPA DIRECT

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82271 TC 2.66 ARIZONA PPO-PPA DIRECT

82271 26 2.66 ARIZONA PPO-PPA DIRECT

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82272 TC 2.66 ARIZONA PPO-PPA DIRECT

82272 26 2.66 ARIZONA PPO-PPA DIRECT

82274 13.28 ARIZONA PPO-PPA DIRECT

82274 TC 13.28 ARIZONA PPO-PPA DIRECT

82274 26 13.28 ARIZONA PPO-PPA DIRECT

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82286 5.72 ARIZONA PPO-PPA DIRECT

82286 TC 5.72 ARIZONA PPO-PPA DIRECT

82286 26 5.72 ARIZONA PPO-PPA DIRECT

82300 19.40 ARIZONA PPO-PPA DIRECT

82300 TC 19.40 ARIZONA PPO-PPA DIRECT

82300 26 19.40 ARIZONA PPO-PPA DIRECT

82306 24.71 ARIZONA PPO-PPA DIRECT

82306 TC 24.71 ARIZONA PPO-PPA DIRECT

82306 26 24.71 ARIZONA PPO-PPA DIRECT

82308 22.47 ARIZONA PPO-PPA DIRECT

82308 TC 22.47 ARIZONA PPO-PPA DIRECT

82308 26 22.47 ARIZONA PPO-PPA DIRECT

82310 4.29 ARIZONA PPO-PPA DIRECT

82310 TC 4.29 ARIZONA PPO-PPA DIRECT

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82330 11.44 ARIZONA PPO-PPA DIRECT

82330 TC 11.44 ARIZONA PPO-PPA DIRECT

82330 26 11.44 ARIZONA PPO-PPA DIRECT

82331 4.29 ARIZONA PPO-PPA DIRECT

82331 TC 4.29 ARIZONA PPO-PPA DIRECT

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82340 TC 5.11 ARIZONA PPO-PPA DIRECT

82340 26 5.11 ARIZONA PPO-PPA DIRECT

82355 9.60 ARIZONA PPO-PPA DIRECT

82355 TC 9.60 ARIZONA PPO-PPA DIRECT

82355 26 9.60 ARIZONA PPO-PPA DIRECT

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82360 10.82 ARIZONA PPO-PPA DIRECT

82360 TC 10.82 ARIZONA PPO-PPA DIRECT

82360 26 10.82 ARIZONA PPO-PPA DIRECT

82365 10.82 ARIZONA PPO-PPA DIRECT

82365 TC 10.82 ARIZONA PPO-PPA DIRECT

82365 26 10.82 ARIZONA PPO-PPA DIRECT

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82370 TC 10.42 ARIZONA PPO-PPA DIRECT

82370 26 10.42 ARIZONA PPO-PPA DIRECT

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82378 TC 15.93 ARIZONA PPO-PPA DIRECT

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82379 TC 14.09 ARIZONA PPO-PPA DIRECT

82379 26 14.09 ARIZONA PPO-PPA DIRECT

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82380 7.76 ARIZONA PPO-PPA DIRECT

82380 TC 7.76 ARIZONA PPO-PPA DIRECT

82380 26 7.76 ARIZONA PPO-PPA DIRECT

82382 14.50 ARIZONA PPO-PPA DIRECT

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82382 26 14.50 ARIZONA PPO-PPA DIRECT

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82435 26 3.88 ARIZONA PPO-PPA DIRECT

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82436 4.29 ARIZONA PPO-PPA DIRECT

82436 TC 4.29 ARIZONA PPO-PPA DIRECT

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82487 26 13.28 ARIZONA PPO-PPA DIRECT

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82488 17.97 ARIZONA PPO-PPA DIRECT

82488 TC 17.97 ARIZONA PPO-PPA DIRECT

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82525 26 10.42 ARIZONA PPO-PPA DIRECT

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82528 18.79 ARIZONA PPO-PPA DIRECT

82528 TC 18.79 ARIZONA PPO-PPA DIRECT

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82552 11.23 ARIZONA PPO-PPA DIRECT

82552 TC 11.23 ARIZONA PPO-PPA DIRECT

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82600 26 16.34 ARIZONA PPO-PPA DIRECT

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82607 12.66 ARIZONA PPO-PPA DIRECT

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82638 10.21 ARIZONA PPO-PPA DIRECT

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82638 26 10.21 ARIZONA PPO-PPA DIRECT

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82646 17.36 ARIZONA PPO-PPA DIRECT

82646 TC 17.36 ARIZONA PPO-PPA DIRECT

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82664 28.80 ARIZONA PPO-PPA DIRECT

82664 TC 28.80 ARIZONA PPO-PPA DIRECT

82664 26 28.80 ARIZONA PPO-PPA DIRECT

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82666 17.97 ARIZONA PPO-PPA DIRECT

82666 TC 17.97 ARIZONA PPO-PPA DIRECT

82666 26 17.97 ARIZONA PPO-PPA DIRECT

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82670 TC 23.49 ARIZONA PPO-PPA DIRECT

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82677 TC 20.22 ARIZONA PPO-PPA DIRECT

82677 26 20.22 ARIZONA PPO-PPA DIRECT

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82690 TC 14.50 ARIZONA PPO-PPA DIRECT

82690 26 14.50 ARIZONA PPO-PPA DIRECT

82693 12.46 ARIZONA PPO-PPA DIRECT

82693 TC 12.46 ARIZONA PPO-PPA DIRECT

82693 26 12.46 ARIZONA PPO-PPA DIRECT

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82696 19.81 ARIZONA PPO-PPA DIRECT

82696 TC 19.81 ARIZONA PPO-PPA DIRECT

82696 26 19.81 ARIZONA PPO-PPA DIRECT

82705 4.29 ARIZONA PPO-PPA DIRECT

82705 TC 4.29 ARIZONA PPO-PPA DIRECT

82705 26 4.29 ARIZONA PPO-PPA DIRECT

82710 14.09 ARIZONA PPO-PPA DIRECT

82710 TC 14.09 ARIZONA PPO-PPA DIRECT

82710 26 14.09 ARIZONA PPO-PPA DIRECT

82715 14.50 ARIZONA PPO-PPA DIRECT

82715 TC 14.50 ARIZONA PPO-PPA DIRECT

82715 26 14.50 ARIZONA PPO-PPA DIRECT

82725 11.23 ARIZONA PPO-PPA DIRECT

82725 TC 11.23 ARIZONA PPO-PPA DIRECT

82725 26 11.23 ARIZONA PPO-PPA DIRECT

82726 15.11 ARIZONA PPO-PPA DIRECT

82726 TC 15.11 ARIZONA PPO-PPA DIRECT

82726 26 15.11 ARIZONA PPO-PPA DIRECT

82728 11.44 ARIZONA PPO-PPA DIRECT

82728 TC 11.44 ARIZONA PPO-PPA DIRECT

82728 26 11.44 ARIZONA PPO-PPA DIRECT

82731 53.92 ARIZONA PPO-PPA DIRECT

82731 TC 53.92 ARIZONA PPO-PPA DIRECT

82731 26 53.92 ARIZONA PPO-PPA DIRECT

82735 15.52 ARIZONA PPO-PPA DIRECT

82735 TC 15.52 ARIZONA PPO-PPA DIRECT

82735 26 15.52 ARIZONA PPO-PPA DIRECT

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82742 16.54 ARIZONA PPO-PPA DIRECT

82742 TC 16.54 ARIZONA PPO-PPA DIRECT

82742 26 16.54 ARIZONA PPO-PPA DIRECT

82746 12.25 ARIZONA PPO-PPA DIRECT

82746 TC 12.25 ARIZONA PPO-PPA DIRECT

82746 26 12.25 ARIZONA PPO-PPA DIRECT

82747 14.50 ARIZONA PPO-PPA DIRECT

82747 TC 14.50 ARIZONA PPO-PPA DIRECT

82747 26 14.50 ARIZONA PPO-PPA DIRECT

82757 14.50 ARIZONA PPO-PPA DIRECT

82757 TC 14.50 ARIZONA PPO-PPA DIRECT

82757 26 14.50 ARIZONA PPO-PPA DIRECT

82759 17.97 ARIZONA PPO-PPA DIRECT

82759 TC 17.97 ARIZONA PPO-PPA DIRECT

82759 26 17.97 ARIZONA PPO-PPA DIRECT

82760 9.40 ARIZONA PPO-PPA DIRECT

82760 TC 9.40 ARIZONA PPO-PPA DIRECT

82760 26 9.40 ARIZONA PPO-PPA DIRECT

82775 17.56 ARIZONA PPO-PPA DIRECT

82775 TC 17.56 ARIZONA PPO-PPA DIRECT

82775 26 17.56 ARIZONA PPO-PPA DIRECT

82776 6.94 ARIZONA PPO-PPA DIRECT

82776 TC 6.94 ARIZONA PPO-PPA DIRECT

82776 26 6.94 ARIZONA PPO-PPA DIRECT

82777 10.62 ARIZONA PPO-PPA DIRECT

82777 TC 10.62 ARIZONA PPO-PPA DIRECT

82777 26 10.62 ARIZONA PPO-PPA DIRECT

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82784 7.76 ARIZONA PPO-PPA DIRECT

82784 TC 7.76 ARIZONA PPO-PPA DIRECT

82784 26 7.76 ARIZONA PPO-PPA DIRECT

82785 13.89 ARIZONA PPO-PPA DIRECT

82785 TC 13.89 ARIZONA PPO-PPA DIRECT

82785 26 13.89 ARIZONA PPO-PPA DIRECT

82787 6.74 ARIZONA PPO-PPA DIRECT

82787 TC 6.74 ARIZONA PPO-PPA DIRECT

82787 26 6.74 ARIZONA PPO-PPA DIRECT

82800 7.15 ARIZONA PPO-PPA DIRECT

82800 TC 7.15 ARIZONA PPO-PPA DIRECT

82800 26 7.15 ARIZONA PPO-PPA DIRECT

82803 16.14 ARIZONA PPO-PPA DIRECT

82803 TC 16.14 ARIZONA PPO-PPA DIRECT

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82805 23.69 ARIZONA PPO-PPA DIRECT

82805 TC 23.69 ARIZONA PPO-PPA DIRECT

82805 26 23.69 ARIZONA PPO-PPA DIRECT

82810 7.35 ARIZONA PPO-PPA DIRECT

82810 TC 7.35 ARIZONA PPO-PPA DIRECT

82810 26 7.35 ARIZONA PPO-PPA DIRECT

82820 8.37 ARIZONA PPO-PPA DIRECT

82820 TC 8.37 ARIZONA PPO-PPA DIRECT

82820 26 8.37 ARIZONA PPO-PPA DIRECT

82930 4.70 ARIZONA PPO-PPA DIRECT

82930 TC 4.70 ARIZONA PPO-PPA DIRECT

82930 26 4.70 ARIZONA PPO-PPA DIRECT

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82938 14.91 ARIZONA PPO-PPA DIRECT

82938 TC 14.91 ARIZONA PPO-PPA DIRECT

82938 26 14.91 ARIZONA PPO-PPA DIRECT

82941 14.71 ARIZONA PPO-PPA DIRECT

82941 TC 14.71 ARIZONA PPO-PPA DIRECT

82941 26 14.71 ARIZONA PPO-PPA DIRECT

82943 12.05 ARIZONA PPO-PPA DIRECT

82943 TC 12.05 ARIZONA PPO-PPA DIRECT

82943 26 12.05 ARIZONA PPO-PPA DIRECT

82945 3.27 ARIZONA PPO-PPA DIRECT

82945 TC 3.27 ARIZONA PPO-PPA DIRECT

82945 26 3.27 ARIZONA PPO-PPA DIRECT

82946 12.66 ARIZONA PPO-PPA DIRECT

82946 TC 12.66 ARIZONA PPO-PPA DIRECT

82946 26 12.66 ARIZONA PPO-PPA DIRECT

82947 3.27 ARIZONA PPO-PPA DIRECT

82947 TC 3.27 ARIZONA PPO-PPA DIRECT

82947 26 3.27 ARIZONA PPO-PPA DIRECT

82948 2.66 ARIZONA PPO-PPA DIRECT

82948 TC 2.66 ARIZONA PPO-PPA DIRECT

82948 26 2.66 ARIZONA PPO-PPA DIRECT

82950 3.88 ARIZONA PPO-PPA DIRECT

82950 TC 3.88 ARIZONA PPO-PPA DIRECT

82950 26 3.88 ARIZONA PPO-PPA DIRECT

82951 10.82 ARIZONA PPO-PPA DIRECT

82951 TC 10.82 ARIZONA PPO-PPA DIRECT

82951 26 10.82 ARIZONA PPO-PPA DIRECT

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82952 3.27 ARIZONA PPO-PPA DIRECT

82952 TC 3.27 ARIZONA PPO-PPA DIRECT

82952 26 3.27 ARIZONA PPO-PPA DIRECT

82953 12.66 ARIZONA PPO-PPA DIRECT

82953 TC 12.66 ARIZONA PPO-PPA DIRECT

82953 26 12.66 ARIZONA PPO-PPA DIRECT

82955 8.17 ARIZONA PPO-PPA DIRECT

82955 TC 8.17 ARIZONA PPO-PPA DIRECT

82955 26 8.17 ARIZONA PPO-PPA DIRECT

82960 5.11 ARIZONA PPO-PPA DIRECT

82960 TC 5.11 ARIZONA PPO-PPA DIRECT

82960 26 5.11 ARIZONA PPO-PPA DIRECT

82962 2.04 ARIZONA PPO-PPA DIRECT

82962 TC 2.04 ARIZONA PPO-PPA DIRECT

82962 26 2.04 ARIZONA PPO-PPA DIRECT

82963 17.97 ARIZONA PPO-PPA DIRECT

82963 TC 17.97 ARIZONA PPO-PPA DIRECT

82963 26 17.97 ARIZONA PPO-PPA DIRECT

82965 6.54 ARIZONA PPO-PPA DIRECT

82965 TC 6.54 ARIZONA PPO-PPA DIRECT

82965 26 6.54 ARIZONA PPO-PPA DIRECT

82975 13.28 ARIZONA PPO-PPA DIRECT

82975 TC 13.28 ARIZONA PPO-PPA DIRECT

82975 26 13.28 ARIZONA PPO-PPA DIRECT

82977 6.13 ARIZONA PPO-PPA DIRECT

82977 TC 6.13 ARIZONA PPO-PPA DIRECT

82977 26 6.13 ARIZONA PPO-PPA DIRECT

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82978 11.85 ARIZONA PPO-PPA DIRECT

82978 TC 11.85 ARIZONA PPO-PPA DIRECT

82978 26 11.85 ARIZONA PPO-PPA DIRECT

82979 5.72 ARIZONA PPO-PPA DIRECT

82979 TC 5.72 ARIZONA PPO-PPA DIRECT

82979 26 5.72 ARIZONA PPO-PPA DIRECT

82980 15.32 ARIZONA PPO-PPA DIRECT

82980 TC 15.32 ARIZONA PPO-PPA DIRECT

82980 26 15.32 ARIZONA PPO-PPA DIRECT

82985 12.66 ARIZONA PPO-PPA DIRECT

82985 TC 12.66 ARIZONA PPO-PPA DIRECT

82985 26 12.66 ARIZONA PPO-PPA DIRECT

83001 15.52 ARIZONA PPO-PPA DIRECT

83001 TC 15.52 ARIZONA PPO-PPA DIRECT

83001 26 15.52 ARIZONA PPO-PPA DIRECT

83002 15.52 ARIZONA PPO-PPA DIRECT

83002 TC 15.52 ARIZONA PPO-PPA DIRECT

83002 26 15.52 ARIZONA PPO-PPA DIRECT

83003 13.89 ARIZONA PPO-PPA DIRECT

83003 TC 13.89 ARIZONA PPO-PPA DIRECT

83003 26 13.89 ARIZONA PPO-PPA DIRECT

83006 17.16 ARIZONA PPO-PPA DIRECT

83006 TC 17.16 ARIZONA PPO-PPA DIRECT

83006 26 17.16 ARIZONA PPO-PPA DIRECT

83008 14.09 ARIZONA PPO-PPA DIRECT

83008 TC 14.09 ARIZONA PPO-PPA DIRECT

83008 26 14.09 ARIZONA PPO-PPA DIRECT

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83009 56.37 ARIZONA PPO-PPA DIRECT

83009 TC 56.37 ARIZONA PPO-PPA DIRECT

83009 26 56.37 ARIZONA PPO-PPA DIRECT

83010 10.62 ARIZONA PPO-PPA DIRECT

83010 TC 10.62 ARIZONA PPO-PPA DIRECT

83010 26 10.62 ARIZONA PPO-PPA DIRECT

83012 14.50 ARIZONA PPO-PPA DIRECT

83012 TC 14.50 ARIZONA PPO-PPA DIRECT

83012 26 14.50 ARIZONA PPO-PPA DIRECT

83013 56.37 ARIZONA PPO-PPA DIRECT

83013 TC 56.37 ARIZONA PPO-PPA DIRECT

83013 26 56.37 ARIZONA PPO-PPA DIRECT

83014 6.54 ARIZONA PPO-PPA DIRECT

83014 TC 6.54 ARIZONA PPO-PPA DIRECT

83014 26 6.54 ARIZONA PPO-PPA DIRECT

83015 15.73 ARIZONA PPO-PPA DIRECT

83015 TC 15.73 ARIZONA PPO-PPA DIRECT

83015 26 15.73 ARIZONA PPO-PPA DIRECT

83018 18.38 ARIZONA PPO-PPA DIRECT

83018 TC 18.38 ARIZONA PPO-PPA DIRECT

83018 26 18.38 ARIZONA PPO-PPA DIRECT

83020 20.59 ARIZONA PPO-PPA DIRECT

83020 TC 10.82 ARIZONA PPO-PPA DIRECT

83020 26 9.76 ARIZONA PPO-PPA DIRECT

83021 15.11 ARIZONA PPO-PPA DIRECT

83021 TC 15.11 ARIZONA PPO-PPA DIRECT

83021 26 15.11 ARIZONA PPO-PPA DIRECT

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83026 2.04 ARIZONA PPO-PPA DIRECT

83026 TC 2.04 ARIZONA PPO-PPA DIRECT

83026 26 2.04 ARIZONA PPO-PPA DIRECT

83030 6.94 ARIZONA PPO-PPA DIRECT

83030 TC 6.94 ARIZONA PPO-PPA DIRECT

83030 26 6.94 ARIZONA PPO-PPA DIRECT

83033 4.90 ARIZONA PPO-PPA DIRECT

83033 TC 4.90 ARIZONA PPO-PPA DIRECT

83033 26 4.90 ARIZONA PPO-PPA DIRECT

83036 8.17 ARIZONA PPO-PPA DIRECT

83036 TC 8.17 ARIZONA PPO-PPA DIRECT

83036 26 8.17 ARIZONA PPO-PPA DIRECT

83037 12.66 ARIZONA PPO-PPA DIRECT

83037 TC 12.66 ARIZONA PPO-PPA DIRECT

83037 26 12.66 ARIZONA PPO-PPA DIRECT

83045 4.08 ARIZONA PPO-PPA DIRECT

83045 TC 4.08 ARIZONA PPO-PPA DIRECT

83045 26 4.08 ARIZONA PPO-PPA DIRECT

83050 6.13 ARIZONA PPO-PPA DIRECT

83050 TC 6.13 ARIZONA PPO-PPA DIRECT

83050 26 6.13 ARIZONA PPO-PPA DIRECT

83051 6.13 ARIZONA PPO-PPA DIRECT

83051 TC 6.13 ARIZONA PPO-PPA DIRECT

83051 26 6.13 ARIZONA PPO-PPA DIRECT

83055 4.08 ARIZONA PPO-PPA DIRECT

83055 TC 4.08 ARIZONA PPO-PPA DIRECT

83055 26 4.08 ARIZONA PPO-PPA DIRECT

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83060 6.94 ARIZONA PPO-PPA DIRECT

83060 TC 6.94 ARIZONA PPO-PPA DIRECT

83060 26 6.94 ARIZONA PPO-PPA DIRECT

83065 5.72 ARIZONA PPO-PPA DIRECT

83065 TC 5.72 ARIZONA PPO-PPA DIRECT

83065 26 5.72 ARIZONA PPO-PPA DIRECT

83068 7.15 ARIZONA PPO-PPA DIRECT

83068 TC 7.15 ARIZONA PPO-PPA DIRECT

83068 26 7.15 ARIZONA PPO-PPA DIRECT

83069 3.27 ARIZONA PPO-PPA DIRECT

83069 TC 3.27 ARIZONA PPO-PPA DIRECT

83069 26 3.27 ARIZONA PPO-PPA DIRECT

83070 3.88 ARIZONA PPO-PPA DIRECT

83070 TC 3.88 ARIZONA PPO-PPA DIRECT

83070 26 3.88 ARIZONA PPO-PPA DIRECT

83071 5.72 ARIZONA PPO-PPA DIRECT

83071 TC 5.72 ARIZONA PPO-PPA DIRECT

83071 26 5.72 ARIZONA PPO-PPA DIRECT

83080 14.09 ARIZONA PPO-PPA DIRECT

83080 TC 14.09 ARIZONA PPO-PPA DIRECT

83080 26 14.09 ARIZONA PPO-PPA DIRECT

83088 24.71 ARIZONA PPO-PPA DIRECT

83088 TC 24.71 ARIZONA PPO-PPA DIRECT

83088 26 24.71 ARIZONA PPO-PPA DIRECT

83090 14.09 ARIZONA PPO-PPA DIRECT

83090 TC 14.09 ARIZONA PPO-PPA DIRECT

83090 26 14.09 ARIZONA PPO-PPA DIRECT

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83150 16.14 ARIZONA PPO-PPA DIRECT

83150 TC 16.14 ARIZONA PPO-PPA DIRECT

83150 26 16.14 ARIZONA PPO-PPA DIRECT

83491 14.71 ARIZONA PPO-PPA DIRECT

83491 TC 14.71 ARIZONA PPO-PPA DIRECT

83491 26 14.71 ARIZONA PPO-PPA DIRECT

83497 10.82 ARIZONA PPO-PPA DIRECT

83497 TC 10.82 ARIZONA PPO-PPA DIRECT

83497 26 10.82 ARIZONA PPO-PPA DIRECT

83498 22.67 ARIZONA PPO-PPA DIRECT

83498 TC 22.67 ARIZONA PPO-PPA DIRECT

83498 26 22.67 ARIZONA PPO-PPA DIRECT

83499 21.04 ARIZONA PPO-PPA DIRECT

83499 TC 21.04 ARIZONA PPO-PPA DIRECT

83499 26 21.04 ARIZONA PPO-PPA DIRECT

83500 18.99 ARIZONA PPO-PPA DIRECT

83500 TC 18.99 ARIZONA PPO-PPA DIRECT

83500 26 18.99 ARIZONA PPO-PPA DIRECT

83505 20.42 ARIZONA PPO-PPA DIRECT

83505 TC 20.42 ARIZONA PPO-PPA DIRECT

83505 26 20.42 ARIZONA PPO-PPA DIRECT

83516 9.60 ARIZONA PPO-PPA DIRECT

83516 TC 9.60 ARIZONA PPO-PPA DIRECT

83516 26 9.60 ARIZONA PPO-PPA DIRECT

83518 7.15 ARIZONA PPO-PPA DIRECT

83518 TC 7.15 ARIZONA PPO-PPA DIRECT

83518 26 7.15 ARIZONA PPO-PPA DIRECT

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83519 11.23 ARIZONA PPO-PPA DIRECT

83519 TC 11.23 ARIZONA PPO-PPA DIRECT

83519 26 11.23 ARIZONA PPO-PPA DIRECT

83520 10.82 ARIZONA PPO-PPA DIRECT

83520 TC 10.82 ARIZONA PPO-PPA DIRECT

83520 26 10.82 ARIZONA PPO-PPA DIRECT

83525 9.60 ARIZONA PPO-PPA DIRECT

83525 TC 9.60 ARIZONA PPO-PPA DIRECT

83525 26 9.60 ARIZONA PPO-PPA DIRECT

83527 10.82 ARIZONA PPO-PPA DIRECT

83527 TC 10.82 ARIZONA PPO-PPA DIRECT

83527 26 10.82 ARIZONA PPO-PPA DIRECT

83528 13.28 ARIZONA PPO-PPA DIRECT

83528 TC 13.28 ARIZONA PPO-PPA DIRECT

83528 26 13.28 ARIZONA PPO-PPA DIRECT

83540 5.51 ARIZONA PPO-PPA DIRECT

83540 TC 5.51 ARIZONA PPO-PPA DIRECT

83540 26 5.51 ARIZONA PPO-PPA DIRECT

83550 7.35 ARIZONA PPO-PPA DIRECT

83550 TC 7.35 ARIZONA PPO-PPA DIRECT

83550 26 7.35 ARIZONA PPO-PPA DIRECT

83570 7.35 ARIZONA PPO-PPA DIRECT

83570 TC 7.35 ARIZONA PPO-PPA DIRECT

83570 26 7.35 ARIZONA PPO-PPA DIRECT

83582 11.85 ARIZONA PPO-PPA DIRECT

83582 TC 11.85 ARIZONA PPO-PPA DIRECT

83582 26 11.85 ARIZONA PPO-PPA DIRECT

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83586 10.82 ARIZONA PPO-PPA DIRECT

83586 TC 10.82 ARIZONA PPO-PPA DIRECT

83586 26 10.82 ARIZONA PPO-PPA DIRECT

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83593 TC 22.06 ARIZONA PPO-PPA DIRECT

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83625 TC 10.62 ARIZONA PPO-PPA DIRECT

83625 26 10.62 ARIZONA PPO-PPA DIRECT

83630 16.34 ARIZONA PPO-PPA DIRECT

83630 TC 16.34 ARIZONA PPO-PPA DIRECT

83630 26 16.34 ARIZONA PPO-PPA DIRECT

83631 16.34 ARIZONA PPO-PPA DIRECT

83631 TC 16.34 ARIZONA PPO-PPA DIRECT

83631 26 16.34 ARIZONA PPO-PPA DIRECT

83632 16.95 ARIZONA PPO-PPA DIRECT

83632 TC 16.95 ARIZONA PPO-PPA DIRECT

83632 26 16.95 ARIZONA PPO-PPA DIRECT

83633 4.70 ARIZONA PPO-PPA DIRECT

83633 TC 4.70 ARIZONA PPO-PPA DIRECT

83633 26 4.70 ARIZONA PPO-PPA DIRECT

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83634 9.60 ARIZONA PPO-PPA DIRECT

83634 TC 9.60 ARIZONA PPO-PPA DIRECT

83634 26 9.60 ARIZONA PPO-PPA DIRECT

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83661 26 18.38 ARIZONA PPO-PPA DIRECT

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83664 TC 15.93 ARIZONA PPO-PPA DIRECT

83664 26 15.93 ARIZONA PPO-PPA DIRECT

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83690 TC 5.72 ARIZONA PPO-PPA DIRECT

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83695 10.82 ARIZONA PPO-PPA DIRECT

83695 TC 10.82 ARIZONA PPO-PPA DIRECT

83695 26 10.82 ARIZONA PPO-PPA DIRECT

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83698 28.39 ARIZONA PPO-PPA DIRECT

83698 TC 28.39 ARIZONA PPO-PPA DIRECT

83698 26 28.39 ARIZONA PPO-PPA DIRECT

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83700 TC 9.40 ARIZONA PPO-PPA DIRECT

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83701 TC 20.83 ARIZONA PPO-PPA DIRECT

83701 26 20.83 ARIZONA PPO-PPA DIRECT

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83719 26 9.80 ARIZONA PPO-PPA DIRECT

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83721 26 7.97 ARIZONA PPO-PPA DIRECT

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83727 26 14.50 ARIZONA PPO-PPA DIRECT

83735 5.51 ARIZONA PPO-PPA DIRECT

83735 TC 5.51 ARIZONA PPO-PPA DIRECT

83735 26 5.51 ARIZONA PPO-PPA DIRECT

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83775 6.13 ARIZONA PPO-PPA DIRECT

83775 TC 6.13 ARIZONA PPO-PPA DIRECT

83775 26 6.13 ARIZONA PPO-PPA DIRECT

83785 20.63 ARIZONA PPO-PPA DIRECT

83785 TC 20.63 ARIZONA PPO-PPA DIRECT

83785 26 20.63 ARIZONA PPO-PPA DIRECT

83788 15.11 ARIZONA PPO-PPA DIRECT

83788 TC 15.11 ARIZONA PPO-PPA DIRECT

83788 26 15.11 ARIZONA PPO-PPA DIRECT

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83789 TC 15.11 ARIZONA PPO-PPA DIRECT

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83805 TC 14.71 ARIZONA PPO-PPA DIRECT

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83825 13.68 ARIZONA PPO-PPA DIRECT

83825 TC 13.68 ARIZONA PPO-PPA DIRECT

83825 26 13.68 ARIZONA PPO-PPA DIRECT

83835 14.09 ARIZONA PPO-PPA DIRECT

83835 TC 14.09 ARIZONA PPO-PPA DIRECT

83835 26 14.09 ARIZONA PPO-PPA DIRECT

83840 13.68 ARIZONA PPO-PPA DIRECT

83840 TC 13.68 ARIZONA PPO-PPA DIRECT

83840 26 13.68 ARIZONA PPO-PPA DIRECT

83857 8.99 ARIZONA PPO-PPA DIRECT

83857 TC 8.99 ARIZONA PPO-PPA DIRECT

83857 26 8.99 ARIZONA PPO-PPA DIRECT

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83858 12.46 ARIZONA PPO-PPA DIRECT

83858 TC 12.46 ARIZONA PPO-PPA DIRECT

83858 26 12.46 ARIZONA PPO-PPA DIRECT

83861 14.09 ARIZONA PPO-PPA DIRECT

83861 TC 14.09 ARIZONA PPO-PPA DIRECT

83861 26 14.09 ARIZONA PPO-PPA DIRECT

83864 16.75 ARIZONA PPO-PPA DIRECT

83864 TC 16.75 ARIZONA PPO-PPA DIRECT

83864 26 16.75 ARIZONA PPO-PPA DIRECT

83866 8.17 ARIZONA PPO-PPA DIRECT

83866 TC 8.17 ARIZONA PPO-PPA DIRECT

83866 26 8.17 ARIZONA PPO-PPA DIRECT

83872 4.90 ARIZONA PPO-PPA DIRECT

83872 TC 4.90 ARIZONA PPO-PPA DIRECT

83872 26 4.90 ARIZONA PPO-PPA DIRECT

83873 14.50 ARIZONA PPO-PPA DIRECT

83873 TC 14.50 ARIZONA PPO-PPA DIRECT

83873 26 14.50 ARIZONA PPO-PPA DIRECT

83874 10.82 ARIZONA PPO-PPA DIRECT

83874 TC 10.82 ARIZONA PPO-PPA DIRECT

83874 26 10.82 ARIZONA PPO-PPA DIRECT

83876 16.75 ARIZONA PPO-PPA DIRECT

83876 TC 16.75 ARIZONA PPO-PPA DIRECT

83876 26 16.75 ARIZONA PPO-PPA DIRECT

83880 28.39 ARIZONA PPO-PPA DIRECT

83880 TC 28.39 ARIZONA PPO-PPA DIRECT

83880 26 28.39 ARIZONA PPO-PPA DIRECT

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83883 11.44 ARIZONA PPO-PPA DIRECT

83883 TC 11.44 ARIZONA PPO-PPA DIRECT

83883 26 11.44 ARIZONA PPO-PPA DIRECT

83885 20.42 ARIZONA PPO-PPA DIRECT

83885 TC 20.42 ARIZONA PPO-PPA DIRECT

83885 26 20.42 ARIZONA PPO-PPA DIRECT

83887 19.81 ARIZONA PPO-PPA DIRECT

83887 TC 19.81 ARIZONA PPO-PPA DIRECT

83887 26 19.81 ARIZONA PPO-PPA DIRECT

83915 9.40 ARIZONA PPO-PPA DIRECT

83915 TC 9.40 ARIZONA PPO-PPA DIRECT

83915 26 9.40 ARIZONA PPO-PPA DIRECT

83916 16.75 ARIZONA PPO-PPA DIRECT

83916 TC 16.75 ARIZONA PPO-PPA DIRECT

83916 26 16.75 ARIZONA PPO-PPA DIRECT

83918 13.89 ARIZONA PPO-PPA DIRECT

83918 TC 13.89 ARIZONA PPO-PPA DIRECT

83918 26 13.89 ARIZONA PPO-PPA DIRECT

83919 13.89 ARIZONA PPO-PPA DIRECT

83919 TC 13.89 ARIZONA PPO-PPA DIRECT

83919 26 13.89 ARIZONA PPO-PPA DIRECT

83921 13.89 ARIZONA PPO-PPA DIRECT

83921 TC 13.89 ARIZONA PPO-PPA DIRECT

83921 26 13.89 ARIZONA PPO-PPA DIRECT

83925 16.34 ARIZONA PPO-PPA DIRECT

83925 TC 16.34 ARIZONA PPO-PPA DIRECT

83925 26 16.34 ARIZONA PPO-PPA DIRECT

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83930 5.51 ARIZONA PPO-PPA DIRECT

83930 TC 5.51 ARIZONA PPO-PPA DIRECT

83930 26 5.51 ARIZONA PPO-PPA DIRECT

83935 5.72 ARIZONA PPO-PPA DIRECT

83935 TC 5.72 ARIZONA PPO-PPA DIRECT

83935 26 5.72 ARIZONA PPO-PPA DIRECT

83937 24.92 ARIZONA PPO-PPA DIRECT

83937 TC 24.92 ARIZONA PPO-PPA DIRECT

83937 26 24.92 ARIZONA PPO-PPA DIRECT

83945 10.82 ARIZONA PPO-PPA DIRECT

83945 TC 10.82 ARIZONA PPO-PPA DIRECT

83945 26 10.82 ARIZONA PPO-PPA DIRECT

83950 53.92 ARIZONA PPO-PPA DIRECT

83950 TC 53.92 ARIZONA PPO-PPA DIRECT

83950 26 53.92 ARIZONA PPO-PPA DIRECT

83951 66.58 ARIZONA PPO-PPA DIRECT

83951 TC 66.58 ARIZONA PPO-PPA DIRECT

83951 26 66.58 ARIZONA PPO-PPA DIRECT

83970 34.52 ARIZONA PPO-PPA DIRECT

83970 TC 34.52 ARIZONA PPO-PPA DIRECT

83970 26 34.52 ARIZONA PPO-PPA DIRECT

83986 3.06 ARIZONA PPO-PPA DIRECT

83986 TC 3.06 ARIZONA PPO-PPA DIRECT

83986 26 3.06 ARIZONA PPO-PPA DIRECT

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83987 TC 4.29 ARIZONA PPO-PPA DIRECT

83987 26 4.29 ARIZONA PPO-PPA DIRECT

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83992 12.25 ARIZONA PPO-PPA DIRECT

83992 TC 12.25 ARIZONA PPO-PPA DIRECT

83992 26 12.25 ARIZONA PPO-PPA DIRECT

83993 16.34 ARIZONA PPO-PPA DIRECT

83993 TC 16.34 ARIZONA PPO-PPA DIRECT

83993 26 16.34 ARIZONA PPO-PPA DIRECT

84022 13.07 ARIZONA PPO-PPA DIRECT

84022 TC 13.07 ARIZONA PPO-PPA DIRECT

84022 26 13.07 ARIZONA PPO-PPA DIRECT

84030 4.70 ARIZONA PPO-PPA DIRECT

84030 TC 4.70 ARIZONA PPO-PPA DIRECT

84030 26 4.70 ARIZONA PPO-PPA DIRECT

84035 3.06 ARIZONA PPO-PPA DIRECT

84035 TC 3.06 ARIZONA PPO-PPA DIRECT

84035 26 3.06 ARIZONA PPO-PPA DIRECT

84060 6.13 ARIZONA PPO-PPA DIRECT

84060 TC 6.13 ARIZONA PPO-PPA DIRECT

84060 26 6.13 ARIZONA PPO-PPA DIRECT

84061 6.54 ARIZONA PPO-PPA DIRECT

84061 TC 6.54 ARIZONA PPO-PPA DIRECT

84061 26 6.54 ARIZONA PPO-PPA DIRECT

84066 8.17 ARIZONA PPO-PPA DIRECT

84066 TC 8.17 ARIZONA PPO-PPA DIRECT

84066 26 8.17 ARIZONA PPO-PPA DIRECT

84075 4.29 ARIZONA PPO-PPA DIRECT

84075 TC 4.29 ARIZONA PPO-PPA DIRECT

84075 26 4.29 ARIZONA PPO-PPA DIRECT

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84078 6.13 ARIZONA PPO-PPA DIRECT

84078 TC 6.13 ARIZONA PPO-PPA DIRECT

84078 26 6.13 ARIZONA PPO-PPA DIRECT

84080 12.46 ARIZONA PPO-PPA DIRECT

84080 TC 12.46 ARIZONA PPO-PPA DIRECT

84080 26 12.46 ARIZONA PPO-PPA DIRECT

84081 13.89 ARIZONA PPO-PPA DIRECT

84081 TC 13.89 ARIZONA PPO-PPA DIRECT

84081 26 13.89 ARIZONA PPO-PPA DIRECT

84085 5.72 ARIZONA PPO-PPA DIRECT

84085 TC 5.72 ARIZONA PPO-PPA DIRECT

84085 26 5.72 ARIZONA PPO-PPA DIRECT

84087 8.58 ARIZONA PPO-PPA DIRECT

84087 TC 8.58 ARIZONA PPO-PPA DIRECT

84087 26 8.58 ARIZONA PPO-PPA DIRECT

84100 3.88 ARIZONA PPO-PPA DIRECT

84100 TC 3.88 ARIZONA PPO-PPA DIRECT

84100 26 3.88 ARIZONA PPO-PPA DIRECT

84105 4.29 ARIZONA PPO-PPA DIRECT

84105 TC 4.29 ARIZONA PPO-PPA DIRECT

84105 26 4.29 ARIZONA PPO-PPA DIRECT

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84106 TC 3.68 ARIZONA PPO-PPA DIRECT

84106 26 3.68 ARIZONA PPO-PPA DIRECT

84110 7.15 ARIZONA PPO-PPA DIRECT

84110 TC 7.15 ARIZONA PPO-PPA DIRECT

84110 26 7.15 ARIZONA PPO-PPA DIRECT

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84112 54.53 ARIZONA PPO-PPA DIRECT

84112 TC 54.53 ARIZONA PPO-PPA DIRECT

84112 26 54.53 ARIZONA PPO-PPA DIRECT

84119 7.15 ARIZONA PPO-PPA DIRECT

84119 TC 7.15 ARIZONA PPO-PPA DIRECT

84119 26 7.15 ARIZONA PPO-PPA DIRECT

84120 12.25 ARIZONA PPO-PPA DIRECT

84120 TC 12.25 ARIZONA PPO-PPA DIRECT

84120 26 12.25 ARIZONA PPO-PPA DIRECT

84126 21.24 ARIZONA PPO-PPA DIRECT

84126 TC 21.24 ARIZONA PPO-PPA DIRECT

84126 26 21.24 ARIZONA PPO-PPA DIRECT

84127 9.80 ARIZONA PPO-PPA DIRECT

84127 TC 9.80 ARIZONA PPO-PPA DIRECT

84127 26 9.80 ARIZONA PPO-PPA DIRECT

84132 3.88 ARIZONA PPO-PPA DIRECT

84132 TC 3.88 ARIZONA PPO-PPA DIRECT

84132 26 3.88 ARIZONA PPO-PPA DIRECT

84133 3.68 ARIZONA PPO-PPA DIRECT

84133 TC 3.68 ARIZONA PPO-PPA DIRECT

84133 26 3.68 ARIZONA PPO-PPA DIRECT

84134 12.25 ARIZONA PPO-PPA DIRECT

84134 TC 12.25 ARIZONA PPO-PPA DIRECT

84134 26 12.25 ARIZONA PPO-PPA DIRECT

84135 15.93 ARIZONA PPO-PPA DIRECT

84135 TC 15.93 ARIZONA PPO-PPA DIRECT

84135 26 15.93 ARIZONA PPO-PPA DIRECT

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84138 15.93 ARIZONA PPO-PPA DIRECT

84138 TC 15.93 ARIZONA PPO-PPA DIRECT

84138 26 15.93 ARIZONA PPO-PPA DIRECT

84140 17.36 ARIZONA PPO-PPA DIRECT

84140 TC 17.36 ARIZONA PPO-PPA DIRECT

84140 26 17.36 ARIZONA PPO-PPA DIRECT

84143 19.20 ARIZONA PPO-PPA DIRECT

84143 TC 19.20 ARIZONA PPO-PPA DIRECT

84143 26 19.20 ARIZONA PPO-PPA DIRECT

84144 17.56 ARIZONA PPO-PPA DIRECT

84144 TC 17.56 ARIZONA PPO-PPA DIRECT

84144 26 17.56 ARIZONA PPO-PPA DIRECT

84145 0.00 ARIZONA PPO-PPA DIRECT

84145 TC 22.67 ARIZONA PPO-PPA DIRECT

84145 26 22.67 ARIZONA PPO-PPA DIRECT

84146 16.14 ARIZONA PPO-PPA DIRECT

84146 TC 16.14 ARIZONA PPO-PPA DIRECT

84146 26 16.14 ARIZONA PPO-PPA DIRECT

84150 20.83 ARIZONA PPO-PPA DIRECT

84150 TC 20.83 ARIZONA PPO-PPA DIRECT

84150 26 20.83 ARIZONA PPO-PPA DIRECT

84152 15.32 ARIZONA PPO-PPA DIRECT

84152 TC 15.32 ARIZONA PPO-PPA DIRECT

84152 26 15.32 ARIZONA PPO-PPA DIRECT

84153 15.32 ARIZONA PPO-PPA DIRECT

84153 TC 15.32 ARIZONA PPO-PPA DIRECT

84153 26 15.32 ARIZONA PPO-PPA DIRECT

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84154 15.32 ARIZONA PPO-PPA DIRECT

84154 TC 15.32 ARIZONA PPO-PPA DIRECT

84154 26 15.32 ARIZONA PPO-PPA DIRECT

84155 3.06 ARIZONA PPO-PPA DIRECT

84155 TC 3.06 ARIZONA PPO-PPA DIRECT

84155 26 3.06 ARIZONA PPO-PPA DIRECT

84156 3.06 ARIZONA PPO-PPA DIRECT

84156 TC 3.06 ARIZONA PPO-PPA DIRECT

84156 26 3.06 ARIZONA PPO-PPA DIRECT

84157 3.06 ARIZONA PPO-PPA DIRECT

84157 TC 3.06 ARIZONA PPO-PPA DIRECT

84157 26 3.06 ARIZONA PPO-PPA DIRECT

84160 4.29 ARIZONA PPO-PPA DIRECT

84160 TC 4.29 ARIZONA PPO-PPA DIRECT

84160 26 4.29 ARIZONA PPO-PPA DIRECT

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84163 TC 12.66 ARIZONA PPO-PPA DIRECT

84163 26 12.66 ARIZONA PPO-PPA DIRECT

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84165 TC 8.99 ARIZONA PPO-PPA DIRECT

84165 26 9.76 ARIZONA PPO-PPA DIRECT

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84166 26 9.76 ARIZONA PPO-PPA DIRECT

84181 24.06 ARIZONA PPO-PPA DIRECT

84181 TC 14.30 ARIZONA PPO-PPA DIRECT

84181 26 9.76 ARIZONA PPO-PPA DIRECT

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84182 25.28 ARIZONA PPO-PPA DIRECT

84182 TC 15.11 ARIZONA PPO-PPA DIRECT

84182 26 10.16 ARIZONA PPO-PPA DIRECT

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84202 TC 12.05 ARIZONA PPO-PPA DIRECT

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84207 TC 23.49 ARIZONA PPO-PPA DIRECT

84207 26 23.49 ARIZONA PPO-PPA DIRECT

84210 9.19 ARIZONA PPO-PPA DIRECT

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84220 TC 7.97 ARIZONA PPO-PPA DIRECT

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84233 53.92 ARIZONA PPO-PPA DIRECT

84233 TC 53.92 ARIZONA PPO-PPA DIRECT

84233 26 53.92 ARIZONA PPO-PPA DIRECT

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84234 54.33 ARIZONA PPO-PPA DIRECT

84234 TC 54.33 ARIZONA PPO-PPA DIRECT

84234 26 54.33 ARIZONA PPO-PPA DIRECT

84235 43.91 ARIZONA PPO-PPA DIRECT

84235 TC 43.91 ARIZONA PPO-PPA DIRECT

84235 26 43.91 ARIZONA PPO-PPA DIRECT

84238 30.64 ARIZONA PPO-PPA DIRECT

84238 TC 30.64 ARIZONA PPO-PPA DIRECT

84238 26 30.64 ARIZONA PPO-PPA DIRECT

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84252 TC 16.95 ARIZONA PPO-PPA DIRECT

84252 26 16.95 ARIZONA PPO-PPA DIRECT

84255 21.45 ARIZONA PPO-PPA DIRECT

84255 TC 21.45 ARIZONA PPO-PPA DIRECT

84255 26 21.45 ARIZONA PPO-PPA DIRECT

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84260 TC 25.94 ARIZONA PPO-PPA DIRECT

84260 26 25.94 ARIZONA PPO-PPA DIRECT

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84275 26 11.23 ARIZONA PPO-PPA DIRECT

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84285 19.81 ARIZONA PPO-PPA DIRECT

84285 TC 19.81 ARIZONA PPO-PPA DIRECT

84285 26 19.81 ARIZONA PPO-PPA DIRECT

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84375 26 16.34 ARIZONA PPO-PPA DIRECT

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84376 4.70 ARIZONA PPO-PPA DIRECT

84376 TC 4.70 ARIZONA PPO-PPA DIRECT

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84402 TC 21.24 ARIZONA PPO-PPA DIRECT

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84403 TC 21.65 ARIZONA PPO-PPA DIRECT

84403 26 21.65 ARIZONA PPO-PPA DIRECT

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84425 TC 17.77 ARIZONA PPO-PPA DIRECT

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84430 9.80 ARIZONA PPO-PPA DIRECT

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84430 26 9.80 ARIZONA PPO-PPA DIRECT

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84431 0.00 ARIZONA PPO-PPA DIRECT

84431 TC 14.30 ARIZONA PPO-PPA DIRECT

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84446 26 11.85 ARIZONA PPO-PPA DIRECT

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84449 15.11 ARIZONA PPO-PPA DIRECT

84449 TC 15.11 ARIZONA PPO-PPA DIRECT

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84482 26 13.28 ARIZONA PPO-PPA DIRECT

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84484 8.17 ARIZONA PPO-PPA DIRECT

84484 TC 8.17 ARIZONA PPO-PPA DIRECT

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84490 TC 6.33 ARIZONA PPO-PPA DIRECT

84490 26 6.33 ARIZONA PPO-PPA DIRECT

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84512 26 6.54 ARIZONA PPO-PPA DIRECT

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84525 TC 3.06 ARIZONA PPO-PPA DIRECT

84525 26 3.06 ARIZONA PPO-PPA DIRECT

84540 3.88 ARIZONA PPO-PPA DIRECT

84540 TC 3.88 ARIZONA PPO-PPA DIRECT

84540 26 3.88 ARIZONA PPO-PPA DIRECT

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84545 5.51 ARIZONA PPO-PPA DIRECT

84545 TC 5.51 ARIZONA PPO-PPA DIRECT

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84550 TC 3.88 ARIZONA PPO-PPA DIRECT

84550 26 3.88 ARIZONA PPO-PPA DIRECT

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84560 TC 3.88 ARIZONA PPO-PPA DIRECT

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84577 10.42 ARIZONA PPO-PPA DIRECT

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84585 26 13.07 ARIZONA PPO-PPA DIRECT

84586 29.62 ARIZONA PPO-PPA DIRECT

84586 TC 29.62 ARIZONA PPO-PPA DIRECT

84586 26 29.62 ARIZONA PPO-PPA DIRECT

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84588 28.39 ARIZONA PPO-PPA DIRECT

84588 TC 28.39 ARIZONA PPO-PPA DIRECT

84588 26 28.39 ARIZONA PPO-PPA DIRECT

84590 9.80 ARIZONA PPO-PPA DIRECT

84590 TC 9.80 ARIZONA PPO-PPA DIRECT

84590 26 9.80 ARIZONA PPO-PPA DIRECT

84591 9.80 ARIZONA PPO-PPA DIRECT

84591 TC 9.80 ARIZONA PPO-PPA DIRECT

84591 26 9.80 ARIZONA PPO-PPA DIRECT

84597 11.44 ARIZONA PPO-PPA DIRECT

84597 TC 11.44 ARIZONA PPO-PPA DIRECT

84597 26 11.44 ARIZONA PPO-PPA DIRECT

84600 13.48 ARIZONA PPO-PPA DIRECT

84600 TC 13.48 ARIZONA PPO-PPA DIRECT

84600 26 13.48 ARIZONA PPO-PPA DIRECT

84620 10.01 ARIZONA PPO-PPA DIRECT

84620 TC 10.01 ARIZONA PPO-PPA DIRECT

84620 26 10.01 ARIZONA PPO-PPA DIRECT

84630 9.60 ARIZONA PPO-PPA DIRECT

84630 TC 9.60 ARIZONA PPO-PPA DIRECT

84630 26 9.60 ARIZONA PPO-PPA DIRECT

84681 17.36 ARIZONA PPO-PPA DIRECT

84681 TC 17.36 ARIZONA PPO-PPA DIRECT

84681 26 17.36 ARIZONA PPO-PPA DIRECT

84702 12.66 ARIZONA PPO-PPA DIRECT

84702 TC 12.66 ARIZONA PPO-PPA DIRECT

84702 26 12.66 ARIZONA PPO-PPA DIRECT

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84703 6.33 ARIZONA PPO-PPA DIRECT

84703 TC 6.33 ARIZONA PPO-PPA DIRECT

84703 26 6.33 ARIZONA PPO-PPA DIRECT

84704 12.66 ARIZONA PPO-PPA DIRECT

84704 TC 12.66 ARIZONA PPO-PPA DIRECT

84704 26 12.66 ARIZONA PPO-PPA DIRECT

84830 8.37 ARIZONA PPO-PPA DIRECT

84830 TC 8.37 ARIZONA PPO-PPA DIRECT

84830 26 8.37 ARIZONA PPO-PPA DIRECT

84999 0.00 ARIZONA PPO-PPA DIRECT

85002 3.68 ARIZONA PPO-PPA DIRECT

85002 TC 3.68 ARIZONA PPO-PPA DIRECT

85002 26 3.68 ARIZONA PPO-PPA DIRECT

85004 5.51 ARIZONA PPO-PPA DIRECT

85004 TC 5.51 ARIZONA PPO-PPA DIRECT

85004 26 5.51 ARIZONA PPO-PPA DIRECT

85007 2.86 ARIZONA PPO-PPA DIRECT

85007 TC 2.86 ARIZONA PPO-PPA DIRECT

85007 26 2.86 ARIZONA PPO-PPA DIRECT

85008 2.86 ARIZONA PPO-PPA DIRECT

85008 TC 2.86 ARIZONA PPO-PPA DIRECT

85008 26 2.86 ARIZONA PPO-PPA DIRECT

85009 3.06 ARIZONA PPO-PPA DIRECT

85009 TC 3.06 ARIZONA PPO-PPA DIRECT

85009 26 3.06 ARIZONA PPO-PPA DIRECT

85013 2.04 ARIZONA PPO-PPA DIRECT

85013 TC 2.04 ARIZONA PPO-PPA DIRECT

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85013 26 2.04 ARIZONA PPO-PPA DIRECT

85014 2.04 ARIZONA PPO-PPA DIRECT

85014 TC 2.04 ARIZONA PPO-PPA DIRECT

85014 26 2.04 ARIZONA PPO-PPA DIRECT

85018 2.04 ARIZONA PPO-PPA DIRECT

85018 TC 2.04 ARIZONA PPO-PPA DIRECT

85018 26 2.04 ARIZONA PPO-PPA DIRECT

85025 6.54 ARIZONA PPO-PPA DIRECT

85025 TC 6.54 ARIZONA PPO-PPA DIRECT

85025 26 6.54 ARIZONA PPO-PPA DIRECT

85027 5.51 ARIZONA PPO-PPA DIRECT

85027 TC 5.51 ARIZONA PPO-PPA DIRECT

85027 26 5.51 ARIZONA PPO-PPA DIRECT

85032 3.68 ARIZONA PPO-PPA DIRECT

85032 TC 3.68 ARIZONA PPO-PPA DIRECT

85032 26 3.68 ARIZONA PPO-PPA DIRECT

85041 2.45 ARIZONA PPO-PPA DIRECT

85041 TC 2.45 ARIZONA PPO-PPA DIRECT

85041 26 2.45 ARIZONA PPO-PPA DIRECT

85044 3.68 ARIZONA PPO-PPA DIRECT

85044 TC 3.68 ARIZONA PPO-PPA DIRECT

85044 26 3.68 ARIZONA PPO-PPA DIRECT

85045 3.27 ARIZONA PPO-PPA DIRECT

85045 TC 3.27 ARIZONA PPO-PPA DIRECT

85045 26 3.27 ARIZONA PPO-PPA DIRECT

85046 4.70 ARIZONA PPO-PPA DIRECT

85046 TC 4.70 ARIZONA PPO-PPA DIRECT

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85046 26 4.70 ARIZONA PPO-PPA DIRECT

85048 2.04 ARIZONA PPO-PPA DIRECT

85048 TC 2.04 ARIZONA PPO-PPA DIRECT

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85049 3.68 ARIZONA PPO-PPA DIRECT

85049 TC 3.68 ARIZONA PPO-PPA DIRECT

85049 26 3.68 ARIZONA PPO-PPA DIRECT

85055 22.47 ARIZONA PPO-PPA DIRECT

85055 TC 22.47 ARIZONA PPO-PPA DIRECT

85055 26 22.47 ARIZONA PPO-PPA DIRECT

85060 12.04 ARIZONA PPO-PPA DIRECT

85097 25.12 ARIZONA PPO-PPA DIRECT

85130 10.01 ARIZONA PPO-PPA DIRECT

85130 TC 10.01 ARIZONA PPO-PPA DIRECT

85130 26 10.01 ARIZONA PPO-PPA DIRECT

85170 3.06 ARIZONA PPO-PPA DIRECT

85170 TC 3.06 ARIZONA PPO-PPA DIRECT

85170 26 3.06 ARIZONA PPO-PPA DIRECT

85175 3.88 ARIZONA PPO-PPA DIRECT

85175 TC 3.88 ARIZONA PPO-PPA DIRECT

85175 26 3.88 ARIZONA PPO-PPA DIRECT

85210 10.82 ARIZONA PPO-PPA DIRECT

85210 TC 10.82 ARIZONA PPO-PPA DIRECT

85210 26 10.82 ARIZONA PPO-PPA DIRECT

85220 14.71 ARIZONA PPO-PPA DIRECT

85220 TC 14.71 ARIZONA PPO-PPA DIRECT

85220 26 14.71 ARIZONA PPO-PPA DIRECT

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85230 14.91 ARIZONA PPO-PPA DIRECT

85230 TC 14.91 ARIZONA PPO-PPA DIRECT

85230 26 14.91 ARIZONA PPO-PPA DIRECT

85240 14.91 ARIZONA PPO-PPA DIRECT

85240 TC 14.91 ARIZONA PPO-PPA DIRECT

85240 26 14.91 ARIZONA PPO-PPA DIRECT

85244 17.16 ARIZONA PPO-PPA DIRECT

85244 TC 17.16 ARIZONA PPO-PPA DIRECT

85244 26 17.16 ARIZONA PPO-PPA DIRECT

85245 19.20 ARIZONA PPO-PPA DIRECT

85245 TC 19.20 ARIZONA PPO-PPA DIRECT

85245 26 19.20 ARIZONA PPO-PPA DIRECT

85246 19.20 ARIZONA PPO-PPA DIRECT

85246 TC 19.20 ARIZONA PPO-PPA DIRECT

85246 26 19.20 ARIZONA PPO-PPA DIRECT

85247 19.20 ARIZONA PPO-PPA DIRECT

85247 TC 19.20 ARIZONA PPO-PPA DIRECT

85247 26 19.20 ARIZONA PPO-PPA DIRECT

85250 15.93 ARIZONA PPO-PPA DIRECT

85250 TC 15.93 ARIZONA PPO-PPA DIRECT

85250 26 15.93 ARIZONA PPO-PPA DIRECT

85260 14.91 ARIZONA PPO-PPA DIRECT

85260 TC 14.91 ARIZONA PPO-PPA DIRECT

85260 26 14.91 ARIZONA PPO-PPA DIRECT

85270 14.91 ARIZONA PPO-PPA DIRECT

85270 TC 14.91 ARIZONA PPO-PPA DIRECT

85270 26 14.91 ARIZONA PPO-PPA DIRECT

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85280 16.14 ARIZONA PPO-PPA DIRECT

85280 TC 16.14 ARIZONA PPO-PPA DIRECT

85280 26 16.14 ARIZONA PPO-PPA DIRECT

85290 13.68 ARIZONA PPO-PPA DIRECT

85290 TC 13.68 ARIZONA PPO-PPA DIRECT

85290 26 13.68 ARIZONA PPO-PPA DIRECT

85291 7.35 ARIZONA PPO-PPA DIRECT

85291 TC 7.35 ARIZONA PPO-PPA DIRECT

85291 26 7.35 ARIZONA PPO-PPA DIRECT

85292 15.93 ARIZONA PPO-PPA DIRECT

85292 TC 15.93 ARIZONA PPO-PPA DIRECT

85292 26 15.93 ARIZONA PPO-PPA DIRECT

85293 15.93 ARIZONA PPO-PPA DIRECT

85293 TC 15.93 ARIZONA PPO-PPA DIRECT

85293 26 15.93 ARIZONA PPO-PPA DIRECT

85300 10.01 ARIZONA PPO-PPA DIRECT

85300 TC 10.01 ARIZONA PPO-PPA DIRECT

85300 26 10.01 ARIZONA PPO-PPA DIRECT

85301 8.99 ARIZONA PPO-PPA DIRECT

85301 TC 8.99 ARIZONA PPO-PPA DIRECT

85301 26 8.99 ARIZONA PPO-PPA DIRECT

85302 10.01 ARIZONA PPO-PPA DIRECT

85302 TC 10.01 ARIZONA PPO-PPA DIRECT

85302 26 10.01 ARIZONA PPO-PPA DIRECT

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85303 TC 11.64 ARIZONA PPO-PPA DIRECT

85303 26 11.64 ARIZONA PPO-PPA DIRECT

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85305 9.80 ARIZONA PPO-PPA DIRECT

85305 TC 9.80 ARIZONA PPO-PPA DIRECT

85305 26 9.80 ARIZONA PPO-PPA DIRECT

85306 12.87 ARIZONA PPO-PPA DIRECT

85306 TC 12.87 ARIZONA PPO-PPA DIRECT

85306 26 12.87 ARIZONA PPO-PPA DIRECT

85307 12.87 ARIZONA PPO-PPA DIRECT

85307 TC 12.87 ARIZONA PPO-PPA DIRECT

85307 26 12.87 ARIZONA PPO-PPA DIRECT

85335 10.82 ARIZONA PPO-PPA DIRECT

85335 TC 10.82 ARIZONA PPO-PPA DIRECT

85335 26 10.82 ARIZONA PPO-PPA DIRECT

85337 8.78 ARIZONA PPO-PPA DIRECT

85337 TC 8.78 ARIZONA PPO-PPA DIRECT

85337 26 8.78 ARIZONA PPO-PPA DIRECT

85345 3.68 ARIZONA PPO-PPA DIRECT

85345 TC 3.68 ARIZONA PPO-PPA DIRECT

85345 26 3.68 ARIZONA PPO-PPA DIRECT

85347 3.47 ARIZONA PPO-PPA DIRECT

85347 TC 3.47 ARIZONA PPO-PPA DIRECT

85347 26 3.47 ARIZONA PPO-PPA DIRECT

85348 3.06 ARIZONA PPO-PPA DIRECT

85348 TC 3.06 ARIZONA PPO-PPA DIRECT

85348 26 3.06 ARIZONA PPO-PPA DIRECT

85360 6.94 ARIZONA PPO-PPA DIRECT

85360 TC 6.94 ARIZONA PPO-PPA DIRECT

85360 26 6.94 ARIZONA PPO-PPA DIRECT

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85362 5.72 ARIZONA PPO-PPA DIRECT

85362 TC 5.72 ARIZONA PPO-PPA DIRECT

85362 26 5.72 ARIZONA PPO-PPA DIRECT

85366 7.15 ARIZONA PPO-PPA DIRECT

85366 TC 7.15 ARIZONA PPO-PPA DIRECT

85366 26 7.15 ARIZONA PPO-PPA DIRECT

85370 9.60 ARIZONA PPO-PPA DIRECT

85370 TC 9.60 ARIZONA PPO-PPA DIRECT

85370 26 9.60 ARIZONA PPO-PPA DIRECT

85378 5.92 ARIZONA PPO-PPA DIRECT

85378 TC 5.92 ARIZONA PPO-PPA DIRECT

85378 26 5.92 ARIZONA PPO-PPA DIRECT

85379 8.58 ARIZONA PPO-PPA DIRECT

85379 TC 8.58 ARIZONA PPO-PPA DIRECT

85379 26 8.58 ARIZONA PPO-PPA DIRECT

85380 8.58 ARIZONA PPO-PPA DIRECT

85380 TC 8.58 ARIZONA PPO-PPA DIRECT

85380 26 8.58 ARIZONA PPO-PPA DIRECT

85384 7.15 ARIZONA PPO-PPA DIRECT

85384 TC 7.15 ARIZONA PPO-PPA DIRECT

85384 26 7.15 ARIZONA PPO-PPA DIRECT

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85385 TC 7.15 ARIZONA PPO-PPA DIRECT

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85390 TC 4.29 ARIZONA PPO-PPA DIRECT

85390 26 9.76 ARIZONA PPO-PPA DIRECT

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85396 10.35 ARIZONA PPO-PPA DIRECT

85397 18.99 ARIZONA PPO-PPA DIRECT

85397 TC 18.99 ARIZONA PPO-PPA DIRECT

85397 26 18.99 ARIZONA PPO-PPA DIRECT

85400 7.35 ARIZONA PPO-PPA DIRECT

85400 TC 7.35 ARIZONA PPO-PPA DIRECT

85400 26 7.35 ARIZONA PPO-PPA DIRECT

85410 6.54 ARIZONA PPO-PPA DIRECT

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85415 26 14.50 ARIZONA PPO-PPA DIRECT

85420 5.51 ARIZONA PPO-PPA DIRECT

85420 TC 5.51 ARIZONA PPO-PPA DIRECT

85420 26 5.51 ARIZONA PPO-PPA DIRECT

85421 8.58 ARIZONA PPO-PPA DIRECT

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85445 5.72 ARIZONA PPO-PPA DIRECT

85445 TC 5.72 ARIZONA PPO-PPA DIRECT

85445 26 5.72 ARIZONA PPO-PPA DIRECT

85460 6.54 ARIZONA PPO-PPA DIRECT

85460 TC 6.54 ARIZONA PPO-PPA DIRECT

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85460 26 6.54 ARIZONA PPO-PPA DIRECT

85461 5.51 ARIZONA PPO-PPA DIRECT

85461 TC 5.51 ARIZONA PPO-PPA DIRECT

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85475 7.35 ARIZONA PPO-PPA DIRECT

85475 TC 7.35 ARIZONA PPO-PPA DIRECT

85475 26 7.35 ARIZONA PPO-PPA DIRECT

85520 11.03 ARIZONA PPO-PPA DIRECT

85520 TC 11.03 ARIZONA PPO-PPA DIRECT

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85530 TC 11.85 ARIZONA PPO-PPA DIRECT

85530 26 11.85 ARIZONA PPO-PPA DIRECT

85536 5.51 ARIZONA PPO-PPA DIRECT

85536 TC 5.51 ARIZONA PPO-PPA DIRECT

85536 26 5.51 ARIZONA PPO-PPA DIRECT

85540 7.15 ARIZONA PPO-PPA DIRECT

85540 TC 7.15 ARIZONA PPO-PPA DIRECT

85540 26 7.15 ARIZONA PPO-PPA DIRECT

85547 7.15 ARIZONA PPO-PPA DIRECT

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85549 15.73 ARIZONA PPO-PPA DIRECT

85549 TC 15.73 ARIZONA PPO-PPA DIRECT

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85549 26 15.73 ARIZONA PPO-PPA DIRECT

85555 5.51 ARIZONA PPO-PPA DIRECT

85555 TC 5.51 ARIZONA PPO-PPA DIRECT

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85597 26 15.11 ARIZONA PPO-PPA DIRECT

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85598 26 15.11 ARIZONA PPO-PPA DIRECT

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85613 TC 7.97 ARIZONA PPO-PPA DIRECT

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85613 26 7.97 ARIZONA PPO-PPA DIRECT

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85635 TC 8.17 ARIZONA PPO-PPA DIRECT

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85651 TC 3.06 ARIZONA PPO-PPA DIRECT

85651 26 3.06 ARIZONA PPO-PPA DIRECT

85652 2.25 ARIZONA PPO-PPA DIRECT

85652 TC 2.25 ARIZONA PPO-PPA DIRECT

85652 26 2.25 ARIZONA PPO-PPA DIRECT

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85732 TC 5.51 ARIZONA PPO-PPA DIRECT

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85732 26 5.51 ARIZONA PPO-PPA DIRECT

85810 9.80 ARIZONA PPO-PPA DIRECT

85810 TC 9.80 ARIZONA PPO-PPA DIRECT

85810 26 9.80 ARIZONA PPO-PPA DIRECT

85999 0.00 ARIZONA PPO-PPA DIRECT

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86021 26 12.66 ARIZONA PPO-PPA DIRECT

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86022 26 15.32 ARIZONA PPO-PPA DIRECT

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86023 TC 10.42 ARIZONA PPO-PPA DIRECT

86023 26 10.42 ARIZONA PPO-PPA DIRECT

86038 10.21 ARIZONA PPO-PPA DIRECT

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86038 TC 10.21 ARIZONA PPO-PPA DIRECT

86038 26 10.21 ARIZONA PPO-PPA DIRECT

86039 9.40 ARIZONA PPO-PPA DIRECT

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86039 26 9.40 ARIZONA PPO-PPA DIRECT

86060 6.13 ARIZONA PPO-PPA DIRECT

86060 TC 6.13 ARIZONA PPO-PPA DIRECT

86060 26 6.13 ARIZONA PPO-PPA DIRECT

86063 4.90 ARIZONA PPO-PPA DIRECT

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86063 26 4.90 ARIZONA PPO-PPA DIRECT

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86140 4.29 ARIZONA PPO-PPA DIRECT

86140 TC 4.29 ARIZONA PPO-PPA DIRECT

86140 26 4.29 ARIZONA PPO-PPA DIRECT

86141 10.82 ARIZONA PPO-PPA DIRECT

86141 TC 10.82 ARIZONA PPO-PPA DIRECT

86141 26 10.82 ARIZONA PPO-PPA DIRECT

86146 21.24 ARIZONA PPO-PPA DIRECT

86146 TC 21.24 ARIZONA PPO-PPA DIRECT

86146 26 21.24 ARIZONA PPO-PPA DIRECT

86147 21.24 ARIZONA PPO-PPA DIRECT

86147 TC 21.24 ARIZONA PPO-PPA DIRECT

86147 26 21.24 ARIZONA PPO-PPA DIRECT

86148 13.48 ARIZONA PPO-PPA DIRECT

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86148 TC 13.48 ARIZONA PPO-PPA DIRECT

86148 26 13.48 ARIZONA PPO-PPA DIRECT

86152 0.00 ARIZONA PPO-PPA DIRECT

86152 TC 0.00 ARIZONA PPO-PPA DIRECT

86152 26 0.00 ARIZONA PPO-PPA DIRECT

86153 0.00 ARIZONA PPO-PPA DIRECT

86153 TC 0.00 ARIZONA PPO-PPA DIRECT

86153 26 20.56 ARIZONA PPO-PPA DIRECT

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86155 TC 13.48 ARIZONA PPO-PPA DIRECT

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86156 TC 5.51 ARIZONA PPO-PPA DIRECT

86156 26 5.51 ARIZONA PPO-PPA DIRECT

86157 6.74 ARIZONA PPO-PPA DIRECT

86157 TC 6.74 ARIZONA PPO-PPA DIRECT

86157 26 6.74 ARIZONA PPO-PPA DIRECT

86160 10.01 ARIZONA PPO-PPA DIRECT

86160 TC 10.01 ARIZONA PPO-PPA DIRECT

86160 26 10.01 ARIZONA PPO-PPA DIRECT

86161 10.01 ARIZONA PPO-PPA DIRECT

86161 TC 10.01 ARIZONA PPO-PPA DIRECT

86161 26 10.01 ARIZONA PPO-PPA DIRECT

86162 16.95 ARIZONA PPO-PPA DIRECT

86162 TC 16.95 ARIZONA PPO-PPA DIRECT

86162 26 16.95 ARIZONA PPO-PPA DIRECT

86171 8.37 ARIZONA PPO-PPA DIRECT

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86171 TC 8.37 ARIZONA PPO-PPA DIRECT

86171 26 8.37 ARIZONA PPO-PPA DIRECT

86185 7.56 ARIZONA PPO-PPA DIRECT

86185 TC 7.56 ARIZONA PPO-PPA DIRECT

86185 26 7.56 ARIZONA PPO-PPA DIRECT

86200 10.82 ARIZONA PPO-PPA DIRECT

86200 TC 10.82 ARIZONA PPO-PPA DIRECT

86200 26 10.82 ARIZONA PPO-PPA DIRECT

86215 11.03 ARIZONA PPO-PPA DIRECT

86215 TC 11.03 ARIZONA PPO-PPA DIRECT

86215 26 11.03 ARIZONA PPO-PPA DIRECT

86225 11.44 ARIZONA PPO-PPA DIRECT

86225 TC 11.44 ARIZONA PPO-PPA DIRECT

86225 26 11.44 ARIZONA PPO-PPA DIRECT

86226 10.21 ARIZONA PPO-PPA DIRECT

86226 TC 10.21 ARIZONA PPO-PPA DIRECT

86226 26 10.21 ARIZONA PPO-PPA DIRECT

86235 15.11 ARIZONA PPO-PPA DIRECT

86235 TC 15.11 ARIZONA PPO-PPA DIRECT

86235 26 15.11 ARIZONA PPO-PPA DIRECT

86243 17.16 ARIZONA PPO-PPA DIRECT

86243 TC 17.16 ARIZONA PPO-PPA DIRECT

86243 26 17.16 ARIZONA PPO-PPA DIRECT

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86256 TC 10.01 ARIZONA PPO-PPA DIRECT

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86304 26 17.36 ARIZONA PPO-PPA DIRECT

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86309 TC 5.51 ARIZONA PPO-PPA DIRECT

86309 26 5.51 ARIZONA PPO-PPA DIRECT

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86331 TC 10.01 ARIZONA PPO-PPA DIRECT

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86344 TC 6.74 ARIZONA PPO-PPA DIRECT

86344 26 6.74 ARIZONA PPO-PPA DIRECT

86352 0.00 ARIZONA PPO-PPA DIRECT

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86367 TC 31.66 ARIZONA PPO-PPA DIRECT

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86431 TC 4.70 ARIZONA PPO-PPA DIRECT

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86490 4.68 ARIZONA PPO-PPA DIRECT

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86592 TC 3.47 ARIZONA PPO-PPA DIRECT

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86617 TC 13.07 ARIZONA PPO-PPA DIRECT

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86619 11.23 ARIZONA PPO-PPA DIRECT

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86638 TC 10.21 ARIZONA PPO-PPA DIRECT

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86658 TC 10.82 ARIZONA PPO-PPA DIRECT

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86682 TC 10.82 ARIZONA PPO-PPA DIRECT

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86698 TC 10.42 ARIZONA PPO-PPA DIRECT

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86709 TC 9.40 ARIZONA PPO-PPA DIRECT

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86732 TC 11.03 ARIZONA PPO-PPA DIRECT

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86757 TC 16.14 ARIZONA PPO-PPA DIRECT

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86780 TC 14.71 ARIZONA PPO-PPA DIRECT

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86789 26 12.05 ARIZONA PPO-PPA DIRECT

86790 10.82 ARIZONA PPO-PPA DIRECT

86790 TC 10.82 ARIZONA PPO-PPA DIRECT

86790 26 10.82 ARIZONA PPO-PPA DIRECT

86793 11.03 ARIZONA PPO-PPA DIRECT

86793 TC 11.03 ARIZONA PPO-PPA DIRECT

86793 26 11.03 ARIZONA PPO-PPA DIRECT

86800 13.28 ARIZONA PPO-PPA DIRECT

86800 TC 13.28 ARIZONA PPO-PPA DIRECT

86800 26 13.28 ARIZONA PPO-PPA DIRECT

86803 12.05 ARIZONA PPO-PPA DIRECT

86803 TC 12.05 ARIZONA PPO-PPA DIRECT

86803 26 12.05 ARIZONA PPO-PPA DIRECT

86804 13.07 ARIZONA PPO-PPA DIRECT

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86804 TC 13.07 ARIZONA PPO-PPA DIRECT

86804 26 13.07 ARIZONA PPO-PPA DIRECT

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86805 TC 43.71 ARIZONA PPO-PPA DIRECT

86805 26 43.71 ARIZONA PPO-PPA DIRECT

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86806 TC 39.83 ARIZONA PPO-PPA DIRECT

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86807 33.09 ARIZONA PPO-PPA DIRECT

86807 TC 33.09 ARIZONA PPO-PPA DIRECT

86807 26 33.09 ARIZONA PPO-PPA DIRECT

86808 24.92 ARIZONA PPO-PPA DIRECT

86808 TC 24.92 ARIZONA PPO-PPA DIRECT

86808 26 24.92 ARIZONA PPO-PPA DIRECT

86812 21.65 ARIZONA PPO-PPA DIRECT

86812 TC 21.65 ARIZONA PPO-PPA DIRECT

86812 26 21.65 ARIZONA PPO-PPA DIRECT

86813 48.61 ARIZONA PPO-PPA DIRECT

86813 TC 48.61 ARIZONA PPO-PPA DIRECT

86813 26 48.61 ARIZONA PPO-PPA DIRECT

86816 23.28 ARIZONA PPO-PPA DIRECT

86816 TC 23.28 ARIZONA PPO-PPA DIRECT

86816 26 23.28 ARIZONA PPO-PPA DIRECT

86817 53.92 ARIZONA PPO-PPA DIRECT

86817 TC 53.92 ARIZONA PPO-PPA DIRECT

86817 26 53.92 ARIZONA PPO-PPA DIRECT

86821 47.38 ARIZONA PPO-PPA DIRECT

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86821 TC 47.38 ARIZONA PPO-PPA DIRECT

86821 26 47.38 ARIZONA PPO-PPA DIRECT

86822 30.64 ARIZONA PPO-PPA DIRECT

86822 TC 30.64 ARIZONA PPO-PPA DIRECT

86822 26 30.64 ARIZONA PPO-PPA DIRECT

86825 0.00 ARIZONA PPO-PPA DIRECT

86825 TC 68.01 ARIZONA PPO-PPA DIRECT

86825 26 68.01 ARIZONA PPO-PPA DIRECT

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86826 TC 22.67 ARIZONA PPO-PPA DIRECT

86826 26 22.67 ARIZONA PPO-PPA DIRECT

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86828 TC 32.68 ARIZONA PPO-PPA DIRECT

86828 26 32.68 ARIZONA PPO-PPA DIRECT

86829 24.51 ARIZONA PPO-PPA DIRECT

86829 TC 24.51 ARIZONA PPO-PPA DIRECT

86829 26 24.51 ARIZONA PPO-PPA DIRECT

86830 66.58 ARIZONA PPO-PPA DIRECT

86830 TC 66.58 ARIZONA PPO-PPA DIRECT

86830 26 66.58 ARIZONA PPO-PPA DIRECT

86831 57.19 ARIZONA PPO-PPA DIRECT

86831 TC 57.19 ARIZONA PPO-PPA DIRECT

86831 26 57.19 ARIZONA PPO-PPA DIRECT

86832 104.78 ARIZONA PPO-PPA DIRECT

86832 TC 104.78 ARIZONA PPO-PPA DIRECT

86832 26 104.78 ARIZONA PPO-PPA DIRECT

86833 95.18 ARIZONA PPO-PPA DIRECT

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86833 TC 95.18 ARIZONA PPO-PPA DIRECT

86833 26 95.18 ARIZONA PPO-PPA DIRECT

86834 295.13 ARIZONA PPO-PPA DIRECT

86834 TC 295.13 ARIZONA PPO-PPA DIRECT

86834 26 295.13 ARIZONA PPO-PPA DIRECT

86835 266.54 ARIZONA PPO-PPA DIRECT

86835 TC 266.54 ARIZONA PPO-PPA DIRECT

86835 26 266.54 ARIZONA PPO-PPA DIRECT

86849 0.00 ARIZONA PPO-PPA DIRECT

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86850 TC 8.78 ARIZONA PPO-PPA DIRECT

86850 26 8.78 ARIZONA PPO-PPA DIRECT

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86860 TC 10.62 ARIZONA PPO-PPA DIRECT

86860 26 10.62 ARIZONA PPO-PPA DIRECT

86870 16.34 ARIZONA PPO-PPA DIRECT

86870 TC 16.34 ARIZONA PPO-PPA DIRECT

86870 26 16.34 ARIZONA PPO-PPA DIRECT

86880 4.49 ARIZONA PPO-PPA DIRECT

86880 TC 4.49 ARIZONA PPO-PPA DIRECT

86880 26 4.49 ARIZONA PPO-PPA DIRECT

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86885 TC 4.70 ARIZONA PPO-PPA DIRECT

86885 26 4.70 ARIZONA PPO-PPA DIRECT

86886 4.29 ARIZONA PPO-PPA DIRECT

86886 TC 4.29 ARIZONA PPO-PPA DIRECT

86886 26 4.29 ARIZONA PPO-PPA DIRECT

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86890 35.33 ARIZONA PPO-PPA DIRECT

86890 TC 35.33 ARIZONA PPO-PPA DIRECT

86890 26 35.33 ARIZONA PPO-PPA DIRECT

86891 55.15 ARIZONA PPO-PPA DIRECT

86891 TC 55.15 ARIZONA PPO-PPA DIRECT

86891 26 55.15 ARIZONA PPO-PPA DIRECT

86900 2.45 ARIZONA PPO-PPA DIRECT

86900 TC 2.45 ARIZONA PPO-PPA DIRECT

86900 26 2.45 ARIZONA PPO-PPA DIRECT

86901 2.45 ARIZONA PPO-PPA DIRECT

86901 TC 2.45 ARIZONA PPO-PPA DIRECT

86901 26 2.45 ARIZONA PPO-PPA DIRECT

86902 3.27 ARIZONA PPO-PPA DIRECT

86902 TC 3.27 ARIZONA PPO-PPA DIRECT

86902 26 3.27 ARIZONA PPO-PPA DIRECT

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86904 TC 7.97 ARIZONA PPO-PPA DIRECT

86904 26 7.97 ARIZONA PPO-PPA DIRECT

86905 3.27 ARIZONA PPO-PPA DIRECT

86905 TC 3.27 ARIZONA PPO-PPA DIRECT

86905 26 3.27 ARIZONA PPO-PPA DIRECT

86906 6.54 ARIZONA PPO-PPA DIRECT

86906 TC 6.54 ARIZONA PPO-PPA DIRECT

86906 26 6.54 ARIZONA PPO-PPA DIRECT

86910 9.80 ARIZONA PPO-PPA DIRECT

86910 TC 9.80 ARIZONA PPO-PPA DIRECT

86910 26 9.80 ARIZONA PPO-PPA DIRECT

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86911 8.37 ARIZONA PPO-PPA DIRECT

86911 TC 8.37 ARIZONA PPO-PPA DIRECT

86911 26 8.37 ARIZONA PPO-PPA DIRECT

86920 14.50 ARIZONA PPO-PPA DIRECT

86920 TC 14.50 ARIZONA PPO-PPA DIRECT

86920 26 14.50 ARIZONA PPO-PPA DIRECT

86921 11.85 ARIZONA PPO-PPA DIRECT

86921 TC 11.85 ARIZONA PPO-PPA DIRECT

86921 26 11.85 ARIZONA PPO-PPA DIRECT

86922 13.28 ARIZONA PPO-PPA DIRECT

86922 TC 13.28 ARIZONA PPO-PPA DIRECT

86922 26 13.28 ARIZONA PPO-PPA DIRECT

86923 10.62 ARIZONA PPO-PPA DIRECT

86923 TC 10.62 ARIZONA PPO-PPA DIRECT

86923 26 10.62 ARIZONA PPO-PPA DIRECT

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86927 TC 5.72 ARIZONA PPO-PPA DIRECT

86927 26 5.72 ARIZONA PPO-PPA DIRECT

86930 44.12 ARIZONA PPO-PPA DIRECT

86930 TC 44.12 ARIZONA PPO-PPA DIRECT

86930 26 44.12 ARIZONA PPO-PPA DIRECT

86931 33.09 ARIZONA PPO-PPA DIRECT

86931 TC 33.09 ARIZONA PPO-PPA DIRECT

86931 26 33.09 ARIZONA PPO-PPA DIRECT

86932 44.12 ARIZONA PPO-PPA DIRECT

86932 TC 44.12 ARIZONA PPO-PPA DIRECT

86932 26 44.12 ARIZONA PPO-PPA DIRECT

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86940 6.94 ARIZONA PPO-PPA DIRECT

86940 TC 6.94 ARIZONA PPO-PPA DIRECT

86940 26 6.94 ARIZONA PPO-PPA DIRECT

86941 10.21 ARIZONA PPO-PPA DIRECT

86941 TC 10.21 ARIZONA PPO-PPA DIRECT

86941 26 10.21 ARIZONA PPO-PPA DIRECT

86945 12.25 ARIZONA PPO-PPA DIRECT

86945 TC 12.25 ARIZONA PPO-PPA DIRECT

86945 26 12.25 ARIZONA PPO-PPA DIRECT

86950 27.37 ARIZONA PPO-PPA DIRECT

86950 TC 27.37 ARIZONA PPO-PPA DIRECT

86950 26 27.37 ARIZONA PPO-PPA DIRECT

86960 12.25 ARIZONA PPO-PPA DIRECT

86960 TC 12.25 ARIZONA PPO-PPA DIRECT

86960 26 12.25 ARIZONA PPO-PPA DIRECT

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86965 TC 11.03 ARIZONA PPO-PPA DIRECT

86965 26 11.03 ARIZONA PPO-PPA DIRECT

86970 8.78 ARIZONA PPO-PPA DIRECT

86970 TC 8.78 ARIZONA PPO-PPA DIRECT

86970 26 8.78 ARIZONA PPO-PPA DIRECT

86971 8.78 ARIZONA PPO-PPA DIRECT

86971 TC 8.78 ARIZONA PPO-PPA DIRECT

86971 26 8.78 ARIZONA PPO-PPA DIRECT

86972 14.09 ARIZONA PPO-PPA DIRECT

86972 TC 14.09 ARIZONA PPO-PPA DIRECT

86972 26 14.09 ARIZONA PPO-PPA DIRECT

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86975 11.85 ARIZONA PPO-PPA DIRECT

86975 TC 11.85 ARIZONA PPO-PPA DIRECT

86975 26 11.85 ARIZONA PPO-PPA DIRECT

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86977 TC 11.85 ARIZONA PPO-PPA DIRECT

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86978 TC 11.85 ARIZONA PPO-PPA DIRECT

86978 26 11.85 ARIZONA PPO-PPA DIRECT

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86985 26 8.78 ARIZONA PPO-PPA DIRECT

86999 0.00 ARIZONA PPO-PPA DIRECT

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87001 TC 11.03 ARIZONA PPO-PPA DIRECT

87001 26 11.03 ARIZONA PPO-PPA DIRECT

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87040 8.58 ARIZONA PPO-PPA DIRECT

87040 TC 8.58 ARIZONA PPO-PPA DIRECT

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87040 26 8.58 ARIZONA PPO-PPA DIRECT

87045 7.97 ARIZONA PPO-PPA DIRECT

87045 TC 7.97 ARIZONA PPO-PPA DIRECT

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87046 TC 7.97 ARIZONA PPO-PPA DIRECT

87046 26 7.97 ARIZONA PPO-PPA DIRECT

87070 7.15 ARIZONA PPO-PPA DIRECT

87070 TC 7.15 ARIZONA PPO-PPA DIRECT

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87073 TC 7.97 ARIZONA PPO-PPA DIRECT

87073 26 7.97 ARIZONA PPO-PPA DIRECT

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87076 6.74 ARIZONA PPO-PPA DIRECT

87076 TC 6.74 ARIZONA PPO-PPA DIRECT

87076 26 6.74 ARIZONA PPO-PPA DIRECT

87077 6.74 ARIZONA PPO-PPA DIRECT

87077 TC 6.74 ARIZONA PPO-PPA DIRECT

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87081 5.51 ARIZONA PPO-PPA DIRECT

87081 TC 5.51 ARIZONA PPO-PPA DIRECT

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87081 26 5.51 ARIZONA PPO-PPA DIRECT

87084 7.15 ARIZONA PPO-PPA DIRECT

87084 TC 7.15 ARIZONA PPO-PPA DIRECT

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87086 6.74 ARIZONA PPO-PPA DIRECT

87086 TC 6.74 ARIZONA PPO-PPA DIRECT

87086 26 6.74 ARIZONA PPO-PPA DIRECT

87088 6.74 ARIZONA PPO-PPA DIRECT

87088 TC 6.74 ARIZONA PPO-PPA DIRECT

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87101 TC 6.54 ARIZONA PPO-PPA DIRECT

87101 26 6.54 ARIZONA PPO-PPA DIRECT

87102 6.94 ARIZONA PPO-PPA DIRECT

87102 TC 6.94 ARIZONA PPO-PPA DIRECT

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87106 TC 8.58 ARIZONA PPO-PPA DIRECT

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87107 TC 8.58 ARIZONA PPO-PPA DIRECT

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87109 12.87 ARIZONA PPO-PPA DIRECT

87109 TC 12.87 ARIZONA PPO-PPA DIRECT

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87109 26 12.87 ARIZONA PPO-PPA DIRECT

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87110 TC 16.34 ARIZONA PPO-PPA DIRECT

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87116 TC 8.99 ARIZONA PPO-PPA DIRECT

87116 26 8.99 ARIZONA PPO-PPA DIRECT

87118 9.19 ARIZONA PPO-PPA DIRECT

87118 TC 9.19 ARIZONA PPO-PPA DIRECT

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87140 TC 4.70 ARIZONA PPO-PPA DIRECT

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87143 TC 10.42 ARIZONA PPO-PPA DIRECT

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87147 TC 4.29 ARIZONA PPO-PPA DIRECT

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87149 TC 16.75 ARIZONA PPO-PPA DIRECT

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87150 17.16 ARIZONA PPO-PPA DIRECT

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87150 26 17.16 ARIZONA PPO-PPA DIRECT

87152 4.29 ARIZONA PPO-PPA DIRECT

87152 TC 4.29 ARIZONA PPO-PPA DIRECT

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87152 26 4.29 ARIZONA PPO-PPA DIRECT

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87153 TC 18.18 ARIZONA PPO-PPA DIRECT

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87158 4.29 ARIZONA PPO-PPA DIRECT

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87164 18.55 ARIZONA PPO-PPA DIRECT

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87168 TC 3.47 ARIZONA PPO-PPA DIRECT

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87177 7.35 ARIZONA PPO-PPA DIRECT

87177 TC 7.35 ARIZONA PPO-PPA DIRECT

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87177 26 7.35 ARIZONA PPO-PPA DIRECT

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87181 TC 3.88 ARIZONA PPO-PPA DIRECT

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87187 TC 8.78 ARIZONA PPO-PPA DIRECT

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87197 26 12.66 ARIZONA PPO-PPA DIRECT

87205 3.47 ARIZONA PPO-PPA DIRECT

87205 TC 3.47 ARIZONA PPO-PPA DIRECT

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87205 26 3.47 ARIZONA PPO-PPA DIRECT

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87220 TC 3.47 ARIZONA PPO-PPA DIRECT

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87230 TC 16.54 ARIZONA PPO-PPA DIRECT

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87252 TC 21.85 ARIZONA PPO-PPA DIRECT

87252 26 21.85 ARIZONA PPO-PPA DIRECT

87253 16.95 ARIZONA PPO-PPA DIRECT

87253 TC 16.95 ARIZONA PPO-PPA DIRECT

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87253 26 16.95 ARIZONA PPO-PPA DIRECT

87254 16.34 ARIZONA PPO-PPA DIRECT

87254 TC 16.34 ARIZONA PPO-PPA DIRECT

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87255 28.39 ARIZONA PPO-PPA DIRECT

87255 TC 28.39 ARIZONA PPO-PPA DIRECT

87255 26 28.39 ARIZONA PPO-PPA DIRECT

87260 10.01 ARIZONA PPO-PPA DIRECT

87260 TC 10.01 ARIZONA PPO-PPA DIRECT

87260 26 10.01 ARIZONA PPO-PPA DIRECT

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87265 TC 10.01 ARIZONA PPO-PPA DIRECT

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87267 TC 10.01 ARIZONA PPO-PPA DIRECT

87267 26 10.01 ARIZONA PPO-PPA DIRECT

87269 10.01 ARIZONA PPO-PPA DIRECT

87269 TC 10.01 ARIZONA PPO-PPA DIRECT

87269 26 10.01 ARIZONA PPO-PPA DIRECT

87270 10.01 ARIZONA PPO-PPA DIRECT

87270 TC 10.01 ARIZONA PPO-PPA DIRECT

87270 26 10.01 ARIZONA PPO-PPA DIRECT

87271 10.01 ARIZONA PPO-PPA DIRECT

87271 TC 10.01 ARIZONA PPO-PPA DIRECT

87271 26 10.01 ARIZONA PPO-PPA DIRECT

87272 10.01 ARIZONA PPO-PPA DIRECT

87272 TC 10.01 ARIZONA PPO-PPA DIRECT

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87272 26 10.01 ARIZONA PPO-PPA DIRECT

87273 10.01 ARIZONA PPO-PPA DIRECT

87273 TC 10.01 ARIZONA PPO-PPA DIRECT

87273 26 10.01 ARIZONA PPO-PPA DIRECT

87274 10.01 ARIZONA PPO-PPA DIRECT

87274 TC 10.01 ARIZONA PPO-PPA DIRECT

87274 26 10.01 ARIZONA PPO-PPA DIRECT

87275 10.01 ARIZONA PPO-PPA DIRECT

87275 TC 10.01 ARIZONA PPO-PPA DIRECT

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87276 10.01 ARIZONA PPO-PPA DIRECT

87276 TC 10.01 ARIZONA PPO-PPA DIRECT

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87277 10.01 ARIZONA PPO-PPA DIRECT

87277 TC 10.01 ARIZONA PPO-PPA DIRECT

87277 26 10.01 ARIZONA PPO-PPA DIRECT

87278 10.01 ARIZONA PPO-PPA DIRECT

87278 TC 10.01 ARIZONA PPO-PPA DIRECT

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87279 10.01 ARIZONA PPO-PPA DIRECT

87279 TC 10.01 ARIZONA PPO-PPA DIRECT

87279 26 10.01 ARIZONA PPO-PPA DIRECT

87280 10.01 ARIZONA PPO-PPA DIRECT

87280 TC 10.01 ARIZONA PPO-PPA DIRECT

87280 26 10.01 ARIZONA PPO-PPA DIRECT

87281 10.01 ARIZONA PPO-PPA DIRECT

87281 TC 10.01 ARIZONA PPO-PPA DIRECT

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87283 10.01 ARIZONA PPO-PPA DIRECT

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87285 10.01 ARIZONA PPO-PPA DIRECT

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87290 10.01 ARIZONA PPO-PPA DIRECT

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87290 26 10.01 ARIZONA PPO-PPA DIRECT

87299 10.01 ARIZONA PPO-PPA DIRECT

87299 TC 10.01 ARIZONA PPO-PPA DIRECT

87299 26 10.01 ARIZONA PPO-PPA DIRECT

87300 10.01 ARIZONA PPO-PPA DIRECT

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87301 10.01 ARIZONA PPO-PPA DIRECT

87301 TC 10.01 ARIZONA PPO-PPA DIRECT

87301 26 10.01 ARIZONA PPO-PPA DIRECT

87305 10.01 ARIZONA PPO-PPA DIRECT

87305 TC 10.01 ARIZONA PPO-PPA DIRECT

87305 26 10.01 ARIZONA PPO-PPA DIRECT

87320 10.01 ARIZONA PPO-PPA DIRECT

87320 TC 10.01 ARIZONA PPO-PPA DIRECT

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87324 10.01 ARIZONA PPO-PPA DIRECT

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87327 10.01 ARIZONA PPO-PPA DIRECT

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87327 26 10.01 ARIZONA PPO-PPA DIRECT

87328 10.01 ARIZONA PPO-PPA DIRECT

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87328 26 10.01 ARIZONA PPO-PPA DIRECT

87329 10.01 ARIZONA PPO-PPA DIRECT

87329 TC 10.01 ARIZONA PPO-PPA DIRECT

87329 26 10.01 ARIZONA PPO-PPA DIRECT

87332 10.01 ARIZONA PPO-PPA DIRECT

87332 TC 10.01 ARIZONA PPO-PPA DIRECT

87332 26 10.01 ARIZONA PPO-PPA DIRECT

87335 10.01 ARIZONA PPO-PPA DIRECT

87335 TC 10.01 ARIZONA PPO-PPA DIRECT

87335 26 10.01 ARIZONA PPO-PPA DIRECT

87336 10.01 ARIZONA PPO-PPA DIRECT

87336 TC 10.01 ARIZONA PPO-PPA DIRECT

87336 26 10.01 ARIZONA PPO-PPA DIRECT

87337 10.01 ARIZONA PPO-PPA DIRECT

87337 TC 10.01 ARIZONA PPO-PPA DIRECT

87337 26 10.01 ARIZONA PPO-PPA DIRECT

87338 12.05 ARIZONA PPO-PPA DIRECT

87338 TC 12.05 ARIZONA PPO-PPA DIRECT

87338 26 12.05 ARIZONA PPO-PPA DIRECT

87339 10.01 ARIZONA PPO-PPA DIRECT

87339 TC 10.01 ARIZONA PPO-PPA DIRECT

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87339 26 10.01 ARIZONA PPO-PPA DIRECT

87340 8.58 ARIZONA PPO-PPA DIRECT

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87340 26 8.58 ARIZONA PPO-PPA DIRECT

87341 8.58 ARIZONA PPO-PPA DIRECT

87341 TC 8.58 ARIZONA PPO-PPA DIRECT

87341 26 8.58 ARIZONA PPO-PPA DIRECT

87350 9.60 ARIZONA PPO-PPA DIRECT

87350 TC 9.60 ARIZONA PPO-PPA DIRECT

87350 26 9.60 ARIZONA PPO-PPA DIRECT

87380 13.68 ARIZONA PPO-PPA DIRECT

87380 TC 13.68 ARIZONA PPO-PPA DIRECT

87380 26 13.68 ARIZONA PPO-PPA DIRECT

87385 10.01 ARIZONA PPO-PPA DIRECT

87385 TC 10.01 ARIZONA PPO-PPA DIRECT

87385 26 10.01 ARIZONA PPO-PPA DIRECT

87389 20.42 ARIZONA PPO-PPA DIRECT

87389 TC 20.42 ARIZONA PPO-PPA DIRECT

87389 26 20.42 ARIZONA PPO-PPA DIRECT

87390 14.71 ARIZONA PPO-PPA DIRECT

87390 TC 14.71 ARIZONA PPO-PPA DIRECT

87390 26 14.71 ARIZONA PPO-PPA DIRECT

87391 14.71 ARIZONA PPO-PPA DIRECT

87391 TC 14.71 ARIZONA PPO-PPA DIRECT

87391 26 14.71 ARIZONA PPO-PPA DIRECT

87400 10.01 ARIZONA PPO-PPA DIRECT

87400 TC 10.01 ARIZONA PPO-PPA DIRECT

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87420 10.01 ARIZONA PPO-PPA DIRECT

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87425 10.01 ARIZONA PPO-PPA DIRECT

87425 TC 10.01 ARIZONA PPO-PPA DIRECT

87425 26 10.01 ARIZONA PPO-PPA DIRECT

87427 10.01 ARIZONA PPO-PPA DIRECT

87427 TC 10.01 ARIZONA PPO-PPA DIRECT

87427 26 10.01 ARIZONA PPO-PPA DIRECT

87430 10.01 ARIZONA PPO-PPA DIRECT

87430 TC 10.01 ARIZONA PPO-PPA DIRECT

87430 26 10.01 ARIZONA PPO-PPA DIRECT

87449 10.01 ARIZONA PPO-PPA DIRECT

87449 TC 10.01 ARIZONA PPO-PPA DIRECT

87449 26 10.01 ARIZONA PPO-PPA DIRECT

87450 7.97 ARIZONA PPO-PPA DIRECT

87450 TC 7.97 ARIZONA PPO-PPA DIRECT

87450 26 7.97 ARIZONA PPO-PPA DIRECT

87451 7.97 ARIZONA PPO-PPA DIRECT

87451 TC 7.97 ARIZONA PPO-PPA DIRECT

87451 26 7.97 ARIZONA PPO-PPA DIRECT

87470 16.75 ARIZONA PPO-PPA DIRECT

87470 TC 16.75 ARIZONA PPO-PPA DIRECT

87470 26 16.75 ARIZONA PPO-PPA DIRECT

87471 29.41 ARIZONA PPO-PPA DIRECT

87471 TC 29.41 ARIZONA PPO-PPA DIRECT

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87472 35.95 ARIZONA PPO-PPA DIRECT

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87472 26 35.95 ARIZONA PPO-PPA DIRECT

87475 16.75 ARIZONA PPO-PPA DIRECT

87475 TC 16.75 ARIZONA PPO-PPA DIRECT

87475 26 16.75 ARIZONA PPO-PPA DIRECT

87476 29.41 ARIZONA PPO-PPA DIRECT

87476 TC 29.41 ARIZONA PPO-PPA DIRECT

87476 26 29.41 ARIZONA PPO-PPA DIRECT

87477 35.95 ARIZONA PPO-PPA DIRECT

87477 TC 35.95 ARIZONA PPO-PPA DIRECT

87477 26 35.95 ARIZONA PPO-PPA DIRECT

87480 16.75 ARIZONA PPO-PPA DIRECT

87480 TC 16.75 ARIZONA PPO-PPA DIRECT

87480 26 16.75 ARIZONA PPO-PPA DIRECT

87481 29.41 ARIZONA PPO-PPA DIRECT

87481 TC 29.41 ARIZONA PPO-PPA DIRECT

87481 26 29.41 ARIZONA PPO-PPA DIRECT

87482 34.93 ARIZONA PPO-PPA DIRECT

87482 TC 34.93 ARIZONA PPO-PPA DIRECT

87482 26 34.93 ARIZONA PPO-PPA DIRECT

87485 16.75 ARIZONA PPO-PPA DIRECT

87485 TC 16.75 ARIZONA PPO-PPA DIRECT

87485 26 16.75 ARIZONA PPO-PPA DIRECT

87486 29.41 ARIZONA PPO-PPA DIRECT

87486 TC 29.41 ARIZONA PPO-PPA DIRECT

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87487 35.95 ARIZONA PPO-PPA DIRECT

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87490 16.75 ARIZONA PPO-PPA DIRECT

87490 TC 16.75 ARIZONA PPO-PPA DIRECT

87490 26 16.75 ARIZONA PPO-PPA DIRECT

87491 29.41 ARIZONA PPO-PPA DIRECT

87491 TC 29.41 ARIZONA PPO-PPA DIRECT

87491 26 29.41 ARIZONA PPO-PPA DIRECT

87492 29.21 ARIZONA PPO-PPA DIRECT

87492 TC 29.21 ARIZONA PPO-PPA DIRECT

87492 26 29.21 ARIZONA PPO-PPA DIRECT

87493 31.04 ARIZONA PPO-PPA DIRECT

87493 TC 31.04 ARIZONA PPO-PPA DIRECT

87493 26 31.04 ARIZONA PPO-PPA DIRECT

87495 16.75 ARIZONA PPO-PPA DIRECT

87495 TC 16.75 ARIZONA PPO-PPA DIRECT

87495 26 16.75 ARIZONA PPO-PPA DIRECT

87496 29.41 ARIZONA PPO-PPA DIRECT

87496 TC 29.41 ARIZONA PPO-PPA DIRECT

87496 26 29.41 ARIZONA PPO-PPA DIRECT

87497 35.95 ARIZONA PPO-PPA DIRECT

87497 TC 35.95 ARIZONA PPO-PPA DIRECT

87497 26 35.95 ARIZONA PPO-PPA DIRECT

87498 29.41 ARIZONA PPO-PPA DIRECT

87498 TC 29.41 ARIZONA PPO-PPA DIRECT

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87500 29.41 ARIZONA PPO-PPA DIRECT

87500 TC 29.41 ARIZONA PPO-PPA DIRECT

87500 26 29.41 ARIZONA PPO-PPA DIRECT

87501 43.50 ARIZONA PPO-PPA DIRECT

87501 TC 43.50 ARIZONA PPO-PPA DIRECT

87501 26 43.50 ARIZONA PPO-PPA DIRECT

87502 71.89 ARIZONA PPO-PPA DIRECT

87502 TC 71.89 ARIZONA PPO-PPA DIRECT

87502 26 71.89 ARIZONA PPO-PPA DIRECT

87503 17.56 ARIZONA PPO-PPA DIRECT

87503 TC 17.56 ARIZONA PPO-PPA DIRECT

87503 26 17.56 ARIZONA PPO-PPA DIRECT

87505 99.67 ARIZONA PPO-PPA DIRECT

87505 TC 99.67 ARIZONA PPO-PPA DIRECT

87505 26 99.67 ARIZONA PPO-PPA DIRECT

87506 165.84 ARIZONA PPO-PPA DIRECT

87506 TC 165.84 ARIZONA PPO-PPA DIRECT

87506 26 165.84 ARIZONA PPO-PPA DIRECT

87507 323.93 ARIZONA PPO-PPA DIRECT

87507 TC 323.93 ARIZONA PPO-PPA DIRECT

87507 26 323.93 ARIZONA PPO-PPA DIRECT

87510 16.75 ARIZONA PPO-PPA DIRECT

87510 TC 16.75 ARIZONA PPO-PPA DIRECT

87510 26 16.75 ARIZONA PPO-PPA DIRECT

87511 29.41 ARIZONA PPO-PPA DIRECT

87511 TC 29.41 ARIZONA PPO-PPA DIRECT

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87512 34.93 ARIZONA PPO-PPA DIRECT

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87512 26 34.93 ARIZONA PPO-PPA DIRECT

87515 16.75 ARIZONA PPO-PPA DIRECT

87515 TC 16.75 ARIZONA PPO-PPA DIRECT

87515 26 16.75 ARIZONA PPO-PPA DIRECT

87516 29.41 ARIZONA PPO-PPA DIRECT

87516 TC 29.41 ARIZONA PPO-PPA DIRECT

87516 26 29.41 ARIZONA PPO-PPA DIRECT

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87517 TC 35.95 ARIZONA PPO-PPA DIRECT

87517 26 35.95 ARIZONA PPO-PPA DIRECT

87520 16.75 ARIZONA PPO-PPA DIRECT

87520 TC 16.75 ARIZONA PPO-PPA DIRECT

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87521 TC 29.41 ARIZONA PPO-PPA DIRECT

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87525 16.75 ARIZONA PPO-PPA DIRECT

87525 TC 16.75 ARIZONA PPO-PPA DIRECT

87525 26 16.75 ARIZONA PPO-PPA DIRECT

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87526 TC 29.41 ARIZONA PPO-PPA DIRECT

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87527 34.93 ARIZONA PPO-PPA DIRECT

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87528 16.75 ARIZONA PPO-PPA DIRECT

87528 TC 16.75 ARIZONA PPO-PPA DIRECT

87528 26 16.75 ARIZONA PPO-PPA DIRECT

87529 29.41 ARIZONA PPO-PPA DIRECT

87529 TC 29.41 ARIZONA PPO-PPA DIRECT

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87531 TC 16.75 ARIZONA PPO-PPA DIRECT

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87534 TC 16.75 ARIZONA PPO-PPA DIRECT

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87535 TC 29.41 ARIZONA PPO-PPA DIRECT

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87536 TC 71.28 ARIZONA PPO-PPA DIRECT

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87537 16.75 ARIZONA PPO-PPA DIRECT

87537 TC 16.75 ARIZONA PPO-PPA DIRECT

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87538 TC 29.41 ARIZONA PPO-PPA DIRECT

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87540 TC 16.75 ARIZONA PPO-PPA DIRECT

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87541 TC 29.41 ARIZONA PPO-PPA DIRECT

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87542 TC 34.93 ARIZONA PPO-PPA DIRECT

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87550 TC 16.75 ARIZONA PPO-PPA DIRECT

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87551 TC 29.41 ARIZONA PPO-PPA DIRECT

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87552 35.95 ARIZONA PPO-PPA DIRECT

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87555 TC 16.75 ARIZONA PPO-PPA DIRECT

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87556 TC 29.41 ARIZONA PPO-PPA DIRECT

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87560 TC 16.75 ARIZONA PPO-PPA DIRECT

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87561 TC 29.41 ARIZONA PPO-PPA DIRECT

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87562 TC 35.95 ARIZONA PPO-PPA DIRECT

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87580 TC 16.75 ARIZONA PPO-PPA DIRECT

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87581 TC 29.41 ARIZONA PPO-PPA DIRECT

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87590 16.75 ARIZONA PPO-PPA DIRECT

87590 TC 16.75 ARIZONA PPO-PPA DIRECT

87590 26 16.75 ARIZONA PPO-PPA DIRECT

87591 29.41 ARIZONA PPO-PPA DIRECT

87591 TC 29.41 ARIZONA PPO-PPA DIRECT

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87620 TC 16.75 ARIZONA PPO-PPA DIRECT

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87621 TC 29.41 ARIZONA PPO-PPA DIRECT

87621 26 29.41 ARIZONA PPO-PPA DIRECT

87622 34.93 ARIZONA PPO-PPA DIRECT

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87622 26 34.93 ARIZONA PPO-PPA DIRECT

87623 27.37 ARIZONA PPO-PPA DIRECT

87623 TC 27.37 ARIZONA PPO-PPA DIRECT

87623 26 27.37 ARIZONA PPO-PPA DIRECT

87624 27.37 ARIZONA PPO-PPA DIRECT

87624 TC 27.37 ARIZONA PPO-PPA DIRECT

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87625 27.37 ARIZONA PPO-PPA DIRECT

87625 TC 27.37 ARIZONA PPO-PPA DIRECT

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87631 105.80 ARIZONA PPO-PPA DIRECT

87631 TC 105.80 ARIZONA PPO-PPA DIRECT

87631 26 105.80 ARIZONA PPO-PPA DIRECT

87632 176.06 ARIZONA PPO-PPA DIRECT

87632 TC 176.06 ARIZONA PPO-PPA DIRECT

87632 26 176.06 ARIZONA PPO-PPA DIRECT

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87633 TC 343.94 ARIZONA PPO-PPA DIRECT

87633 26 343.94 ARIZONA PPO-PPA DIRECT

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87640 TC 29.41 ARIZONA PPO-PPA DIRECT

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87641 TC 29.41 ARIZONA PPO-PPA DIRECT

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87650 TC 16.75 ARIZONA PPO-PPA DIRECT

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87651 TC 29.41 ARIZONA PPO-PPA DIRECT

87651 26 29.41 ARIZONA PPO-PPA DIRECT

87652 34.93 ARIZONA PPO-PPA DIRECT

87652 TC 34.93 ARIZONA PPO-PPA DIRECT

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87653 29.41 ARIZONA PPO-PPA DIRECT

87653 TC 29.41 ARIZONA PPO-PPA DIRECT

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87660 16.75 ARIZONA PPO-PPA DIRECT

87660 TC 16.75 ARIZONA PPO-PPA DIRECT

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87661 TC 27.37 ARIZONA PPO-PPA DIRECT

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87798 TC 29.41 ARIZONA PPO-PPA DIRECT

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87800 26 33.50 ARIZONA PPO-PPA DIRECT

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87801 TC 58.82 ARIZONA PPO-PPA DIRECT

87801 26 58.82 ARIZONA PPO-PPA DIRECT

87802 10.01 ARIZONA PPO-PPA DIRECT

87802 TC 10.01 ARIZONA PPO-PPA DIRECT

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87803 10.01 ARIZONA PPO-PPA DIRECT

87803 TC 10.01 ARIZONA PPO-PPA DIRECT

87803 26 10.01 ARIZONA PPO-PPA DIRECT

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87804 TC 10.01 ARIZONA PPO-PPA DIRECT

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87808 TC 10.01 ARIZONA PPO-PPA DIRECT

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87810 10.01 ARIZONA PPO-PPA DIRECT

87810 TC 10.01 ARIZONA PPO-PPA DIRECT

87810 26 10.01 ARIZONA PPO-PPA DIRECT

87850 10.01 ARIZONA PPO-PPA DIRECT

87850 TC 10.01 ARIZONA PPO-PPA DIRECT

87850 26 10.01 ARIZONA PPO-PPA DIRECT

87880 10.01 ARIZONA PPO-PPA DIRECT

87880 TC 10.01 ARIZONA PPO-PPA DIRECT

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87880 26 10.01 ARIZONA PPO-PPA DIRECT

87899 10.01 ARIZONA PPO-PPA DIRECT

87899 TC 10.01 ARIZONA PPO-PPA DIRECT

87899 26 10.01 ARIZONA PPO-PPA DIRECT

87900 109.27 ARIZONA PPO-PPA DIRECT

87900 TC 109.27 ARIZONA PPO-PPA DIRECT

87900 26 109.27 ARIZONA PPO-PPA DIRECT

87901 215.68 ARIZONA PPO-PPA DIRECT

87901 TC 215.68 ARIZONA PPO-PPA DIRECT

87901 26 215.68 ARIZONA PPO-PPA DIRECT

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87902 TC 215.68 ARIZONA PPO-PPA DIRECT

87902 26 215.68 ARIZONA PPO-PPA DIRECT

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87903 TC 409.30 ARIZONA PPO-PPA DIRECT

87903 26 409.30 ARIZONA PPO-PPA DIRECT

87904 21.85 ARIZONA PPO-PPA DIRECT

87904 TC 21.85 ARIZONA PPO-PPA DIRECT

87904 26 21.85 ARIZONA PPO-PPA DIRECT

87905 0.00 ARIZONA PPO-PPA DIRECT

87905 TC 10.01 ARIZONA PPO-PPA DIRECT

87905 26 10.01 ARIZONA PPO-PPA DIRECT

87906 108.86 ARIZONA PPO-PPA DIRECT

87906 TC 108.86 ARIZONA PPO-PPA DIRECT

87906 26 108.86 ARIZONA PPO-PPA DIRECT

87910 212.41 ARIZONA PPO-PPA DIRECT

87910 TC 212.41 ARIZONA PPO-PPA DIRECT

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87910 26 212.41 ARIZONA PPO-PPA DIRECT

87912 212.41 ARIZONA PPO-PPA DIRECT

87912 TC 212.41 ARIZONA PPO-PPA DIRECT

87912 26 212.41 ARIZONA PPO-PPA DIRECT

87999 0.00 ARIZONA PPO-PPA DIRECT

88000 109.47 ARIZONA PPO-PPA DIRECT

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88007 136.84 ARIZONA PPO-PPA DIRECT

88012 98.44 ARIZONA PPO-PPA DIRECT

88014 98.44 ARIZONA PPO-PPA DIRECT

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88020 169.72 ARIZONA PPO-PPA DIRECT

88025 186.06 ARIZONA PPO-PPA DIRECT

88027 202.61 ARIZONA PPO-PPA DIRECT

88028 98.44 ARIZONA PPO-PPA DIRECT

88029 98.44 ARIZONA PPO-PPA DIRECT

88036 54.74 ARIZONA PPO-PPA DIRECT

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88040 273.68 ARIZONA PPO-PPA DIRECT

88045 27.37 ARIZONA PPO-PPA DIRECT

88099 0.00 ARIZONA PPO-PPA DIRECT

88104 31.88 ARIZONA PPO-PPA DIRECT

88104 TC 17.14 ARIZONA PPO-PPA DIRECT

88104 26 14.74 ARIZONA PPO-PPA DIRECT

88106 40.46 ARIZONA PPO-PPA DIRECT

88106 TC 25.72 ARIZONA PPO-PPA DIRECT

88106 26 14.74 ARIZONA PPO-PPA DIRECT

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88108 38.42 ARIZONA PPO-PPA DIRECT

88108 TC 23.68 ARIZONA PPO-PPA DIRECT

88108 26 14.74 ARIZONA PPO-PPA DIRECT

88112 57.70 ARIZONA PPO-PPA DIRECT

88112 TC 27.35 ARIZONA PPO-PPA DIRECT

88112 26 30.35 ARIZONA PPO-PPA DIRECT

88120 274.88 ARIZONA PPO-PPA DIRECT

88120 TC 242.82 ARIZONA PPO-PPA DIRECT

88120 26 32.06 ARIZONA PPO-PPA DIRECT

88121 232.10 ARIZONA PPO-PPA DIRECT

88121 TC 203.62 ARIZONA PPO-PPA DIRECT

88121 26 28.48 ARIZONA PPO-PPA DIRECT

88125 10.11 ARIZONA PPO-PPA DIRECT

88125 TC 3.46 ARIZONA PPO-PPA DIRECT

88125 26 6.65 ARIZONA PPO-PPA DIRECT

88130 12.66 ARIZONA PPO-PPA DIRECT

88130 TC 12.66 ARIZONA PPO-PPA DIRECT

88130 26 12.66 ARIZONA PPO-PPA DIRECT

88140 6.74 ARIZONA PPO-PPA DIRECT

88140 TC 6.74 ARIZONA PPO-PPA DIRECT

88140 26 6.74 ARIZONA PPO-PPA DIRECT

88141 13.45 ARIZONA PPO-PPA DIRECT

88142 16.95 ARIZONA PPO-PPA DIRECT

88142 TC 16.95 ARIZONA PPO-PPA DIRECT

88142 26 16.95 ARIZONA PPO-PPA DIRECT

88143 16.95 ARIZONA PPO-PPA DIRECT

88143 TC 16.95 ARIZONA PPO-PPA DIRECT

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88143 26 16.95 ARIZONA PPO-PPA DIRECT

88147 9.60 ARIZONA PPO-PPA DIRECT

88147 TC 9.60 ARIZONA PPO-PPA DIRECT

88147 26 9.60 ARIZONA PPO-PPA DIRECT

88148 12.66 ARIZONA PPO-PPA DIRECT

88148 TC 12.66 ARIZONA PPO-PPA DIRECT

88148 26 12.66 ARIZONA PPO-PPA DIRECT

88150 8.78 ARIZONA PPO-PPA DIRECT

88150 TC 8.78 ARIZONA PPO-PPA DIRECT

88150 26 8.78 ARIZONA PPO-PPA DIRECT

88152 8.78 ARIZONA PPO-PPA DIRECT

88152 TC 8.78 ARIZONA PPO-PPA DIRECT

88152 26 8.78 ARIZONA PPO-PPA DIRECT

88153 8.78 ARIZONA PPO-PPA DIRECT

88153 TC 8.78 ARIZONA PPO-PPA DIRECT

88153 26 8.78 ARIZONA PPO-PPA DIRECT

88154 8.78 ARIZONA PPO-PPA DIRECT

88154 TC 8.78 ARIZONA PPO-PPA DIRECT

88154 26 8.78 ARIZONA PPO-PPA DIRECT

88155 5.11 ARIZONA PPO-PPA DIRECT

88155 TC 5.11 ARIZONA PPO-PPA DIRECT

88155 26 5.11 ARIZONA PPO-PPA DIRECT

88160 27.77 ARIZONA PPO-PPA DIRECT

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88161 TC 17.14 ARIZONA PPO-PPA DIRECT

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88161 26 13.29 ARIZONA PPO-PPA DIRECT

88162 41.57 ARIZONA PPO-PPA DIRECT

88162 TC 21.22 ARIZONA PPO-PPA DIRECT

88162 26 20.34 ARIZONA PPO-PPA DIRECT

88164 8.78 ARIZONA PPO-PPA DIRECT

88164 TC 8.78 ARIZONA PPO-PPA DIRECT

88164 26 8.78 ARIZONA PPO-PPA DIRECT

88165 8.78 ARIZONA PPO-PPA DIRECT

88165 TC 8.78 ARIZONA PPO-PPA DIRECT

88165 26 8.78 ARIZONA PPO-PPA DIRECT

88166 8.78 ARIZONA PPO-PPA DIRECT

88166 TC 8.78 ARIZONA PPO-PPA DIRECT

88166 26 8.78 ARIZONA PPO-PPA DIRECT

88167 8.78 ARIZONA PPO-PPA DIRECT

88167 TC 8.78 ARIZONA PPO-PPA DIRECT

88167 26 8.78 ARIZONA PPO-PPA DIRECT

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88175 26 22.26 ARIZONA PPO-PPA DIRECT

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88184 TC 38.99 ARIZONA PPO-PPA DIRECT

88184 26 38.99 ARIZONA PPO-PPA DIRECT

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88185 TC 22.25 ARIZONA PPO-PPA DIRECT

88185 26 22.25 ARIZONA PPO-PPA DIRECT

88187 33.91 ARIZONA PPO-PPA DIRECT

88187 TC 41.29 ARIZONA PPO-PPA DIRECT

88187 26 41.29 ARIZONA PPO-PPA DIRECT

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88188 26 51.25 ARIZONA PPO-PPA DIRECT

88189 53.71 ARIZONA PPO-PPA DIRECT

88189 TC 63.16 ARIZONA PPO-PPA DIRECT

88189 26 63.16 ARIZONA PPO-PPA DIRECT

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88199 TC 0.00 ARIZONA PPO-PPA DIRECT

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88230 TC 97.63 ARIZONA PPO-PPA DIRECT

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88230 26 97.63 ARIZONA PPO-PPA DIRECT

88233 117.85 ARIZONA PPO-PPA DIRECT

88233 TC 117.85 ARIZONA PPO-PPA DIRECT

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88235 TC 123.36 ARIZONA PPO-PPA DIRECT

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88237 TC 105.80 ARIZONA PPO-PPA DIRECT

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88239 TC 123.57 ARIZONA PPO-PPA DIRECT

88239 26 123.57 ARIZONA PPO-PPA DIRECT

88240 8.37 ARIZONA PPO-PPA DIRECT

88240 TC 8.37 ARIZONA PPO-PPA DIRECT

88240 26 8.37 ARIZONA PPO-PPA DIRECT

88241 8.37 ARIZONA PPO-PPA DIRECT

88241 TC 8.37 ARIZONA PPO-PPA DIRECT

88241 26 8.37 ARIZONA PPO-PPA DIRECT

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88245 TC 124.59 ARIZONA PPO-PPA DIRECT

88245 26 124.59 ARIZONA PPO-PPA DIRECT

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88248 TC 145.01 ARIZONA PPO-PPA DIRECT

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88249 TC 145.01 ARIZONA PPO-PPA DIRECT

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88249 26 145.01 ARIZONA PPO-PPA DIRECT

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88261 TC 148.08 ARIZONA PPO-PPA DIRECT

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88262 104.37 ARIZONA PPO-PPA DIRECT

88262 TC 104.37 ARIZONA PPO-PPA DIRECT

88262 26 104.37 ARIZONA PPO-PPA DIRECT

88263 125.81 ARIZONA PPO-PPA DIRECT

88263 TC 125.81 ARIZONA PPO-PPA DIRECT

88263 26 125.81 ARIZONA PPO-PPA DIRECT

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88264 TC 104.37 ARIZONA PPO-PPA DIRECT

88264 26 104.37 ARIZONA PPO-PPA DIRECT

88267 150.53 ARIZONA PPO-PPA DIRECT

88267 TC 150.53 ARIZONA PPO-PPA DIRECT

88267 26 150.53 ARIZONA PPO-PPA DIRECT

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88269 TC 139.29 ARIZONA PPO-PPA DIRECT

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88271 26 17.97 ARIZONA PPO-PPA DIRECT

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88272 TC 22.47 ARIZONA PPO-PPA DIRECT

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88273 TC 26.96 ARIZONA PPO-PPA DIRECT

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88273 26 26.96 ARIZONA PPO-PPA DIRECT

88274 29.21 ARIZONA PPO-PPA DIRECT

88274 TC 29.21 ARIZONA PPO-PPA DIRECT

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88289 26 28.80 ARIZONA PPO-PPA DIRECT

88291 14.52 ARIZONA PPO-PPA DIRECT

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88304 32.96 ARIZONA PPO-PPA DIRECT

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88321 46.46 ARIZONA PPO-PPA DIRECT

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88344 67.17 ARIZONA PPO-PPA DIRECT

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88361 84.55 ARIZONA PPO-PPA DIRECT

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88371 28.15 ARIZONA PPO-PPA DIRECT

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88388 13.50 ARIZONA PPO-PPA DIRECT

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89051 4.70 ARIZONA PPO-PPA DIRECT

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89250 26 954.01 ARIZONA PPO-PPA DIRECT

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93786 26 0.00 ARIZONA PPO-PPA DIRECT

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93931 26 15.07 ARIZONA PPO-PPA DIRECT

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93981 26 21.14 ARIZONA PPO-PPA DIRECT

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94070 TC 31.04 ARIZONA PPO-PPA DIRECT

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Page 677: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

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99512 0.00 ARIZONA PPO-PPA DIRECT

99600 0.00 ARIZONA PPO-PPA DIRECT

Page 679: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

99601 0.00 ARIZONA PPO-PPA DIRECT

99602 0.00 ARIZONA PPO-PPA DIRECT

99605 0.00 ARIZONA PPO-PPA DIRECT

99606 0.00 ARIZONA PPO-PPA DIRECT

99607 0.00 ARIZONA PPO-PPA DIRECT

Page 680: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Research Text

Page 681: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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Page 696: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 697: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 698: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 699: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 700: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 701: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

Page 702: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 703: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 704: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 705: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 706: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Please refer to Provider Contract for contracted rates/values.

Page 707: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 708: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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Page 711: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 712: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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Page 715: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 716: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 717: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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Page 719: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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Page 729: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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Page 734: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 735: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 736: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 737: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 738: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 739: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 740: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 741: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 742: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 743: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 744: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 745: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 746: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

50.000 % discount.

Page 747: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 748: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 749: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 750: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 751: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 752: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 753: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 754: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 755: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

CHARGES FOR ALL NON-INJECTIBLE PRESCRIPTION DRUGS, NON-PRESCRIPTION DR UGS AND

Page 756: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Please refer to Provider Contract for contracted rates/values.

Page 757: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 758: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 759: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 760: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 761: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 762: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 763: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.

Page 764: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 765: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 766: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 767: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 768: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 769: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 770: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.

Page 771: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Please refer to Provider Contract for contracted rates/values.EXPERIMENTAL DRUGS ARE NOT COVERED.Please refer to Provider Contract for contracted rates/values.

Page 772: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.

Page 773: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.

Page 774: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.

Page 775: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.CHARGES FOR ALL NON-INJECTIBLE PRESCRIPTION DRUGS, NON-PRESCRIPTION DR UGS AND INVESTIGATIONAL AND EXPERIMENTAL DRUGS ARE NOT COVERED AS OUTLI NED UNDER THE LIMITATIONS AND EXCLUSIONS IN YOUR PLAN.

CHARGES FOR ALL NON-INJECTIBLE PRESCRIPTION DRUGS, NON-PRESCRIPTION DR UGS AND INVESTIGATIONAL AND EXPERIMENTAL DRUGS ARE NOT COVERED AS OUTLI NED UNDER THE LIMITATIONS AND EXCLUSIONS

Page 776: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

CHARGES FOR ALL NON-INJECTIBLE PRESCRIPTION DRUGS, NON-PRESCRIPTION DR UGS AND INVESTIGATIONAL AND EXPERIMENTAL DRUGS ARE NOT COVERED AS OUTLI NED UNDER THE LIMITATIONS AND EXCLUSIONS IN YOUR PLAN.

CHARGES FOR ALL NON-INJECTIBLE PRESCRIPTION DRUGS, NON-PRESCRIPTION DR UGS AND INVESTIGATIONAL AND EXPERIMENTAL DRUGS ARE NOT COVERED AS OUTLI NED UNDER THE LIMITATIONS AND EXCLUSIONS IN YOUR PLAN.

Page 777: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 778: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Please refer to Provider Contract for contracted rates/values.

Page 779: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Please refer to Provider Contract for contracted rates/values.

Page 780: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Please refer to Provider Contract for contracted rates/values.

Page 781: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 782: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 783: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 784: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 785: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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Page 787: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 788: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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Page 790: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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Page 796: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 797: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 798: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 799: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 800: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 801: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 802: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 803: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 804: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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Page 807: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 808: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 809: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 810: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 811: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 812: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 813: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 814: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 815: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 816: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 817: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

CHARGES FOR ALL NON-INJECTIBLE PRESCRIPTION DRUGS, NON-PRESCRIPTION DR UGS AND INVESTIGATIONAL AND EXPERIMENTAL DRUGS ARE NOT COVERED AS OUTLI NED UNDER THE LIMITATIONS AND EXCLUSIONS IN YOUR PLAN.

Page 818: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 819: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.

Page 820: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 821: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Please refer to Provider Contract for contracted rates/values.

Page 822: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.

Page 823: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.

Page 824: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 825: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Please refer to Provider Contract for contracted rates/values.

Page 826: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.

Page 827: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 828: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 829: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.

Page 830: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO

Page 831: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

Page 832: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 833: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 834: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 835: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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Page 837: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 838: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 839: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 840: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 841: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 842: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 843: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 844: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 845: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 846: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 847: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 848: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 849: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 850: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 851: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 852: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 853: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 854: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 855: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 856: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 857: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 858: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 859: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 860: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 861: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 862: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 863: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 864: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

Page 865: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 866: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 867: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 868: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 869: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 870: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 871: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 872: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 873: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 874: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

Page 875: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 876: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 877: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 878: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 879: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 880: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 881: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 882: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 883: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 884: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 885: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 886: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 887: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 888: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 889: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 890: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 891: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 892: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 893: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 894: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 895: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 896: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 897: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 898: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 899: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 900: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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Page 902: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 903: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

Page 905: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

Page 910: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

Page 916: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

Page 918: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

Page 921: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

Page 923: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 924: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 925: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 926: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

Page 929: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 932: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 942: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 943: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

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50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 953: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

Page 958: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

Page 959: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

50.000 % discount.

Page 961: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

Page 962: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

Page 963: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

50.000 % discount.

Page 965: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

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50.000 % discount.

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50.000 % discount.

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50.000 % discount.

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50.000 % discount.

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50.000 % discount.

Page 972: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

Page 973: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 974: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 976: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

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50.000 % discount.

Page 978: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

Page 979: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 980: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

Page 981: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 983: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 984: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

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50.000 % discount.

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50.000 % discount.

50.000 % discount.

Page 987: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 988: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

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50.000 % discount.

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50.000 % discount.

50.000 % discount.

50.000 % discount.

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50.000 % discount.

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50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 995: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

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50.000 % discount.

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50.000 % discount.

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50.000 % discount.

50.000 % discount.

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50.000 % discount.

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50.000 % discount.

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50.000 % discount.

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50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1013: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1014: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1015: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1016: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1017: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1018: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1019: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

Page 1020: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 1021: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 1022: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1023: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1024: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

Page 1025: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1026: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1027: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1028: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1029: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1030: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1031: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1032: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1033: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1034: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1035: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1036: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1037: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1038: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1039: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1040: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1041: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1042: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1043: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1044: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 1045: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 1046: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1047: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1048: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 1049: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1050: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

Page 1051: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 1052: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1053: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

Page 1054: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 1055: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 1056: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1057: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

Page 1058: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

Page 1059: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1060: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1061: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

Page 1062: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO

Page 1063: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO

Page 1064: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO

Page 1065: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

Page 1066: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1067: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO

Page 1068: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

Page 1069: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO

Page 1070: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO

Page 1071: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO

Page 1072: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO

Page 1073: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

Page 1074: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1075: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1076: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO

Page 1077: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

Page 1078: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1079: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1080: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO

Page 1081: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO

Page 1082: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO

Page 1083: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

Page 1084: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

Page 1085: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1086: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1087: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1088: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO

Page 1089: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

Page 1090: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

Page 1091: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1092: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1093: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1094: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1095: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1096: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 1097: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1098: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.50.000 % discount.

50.000 % discount.

50.000 % discount.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

50.000 % discount.

Page 1099: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1100: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1101: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1102: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1103: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1104: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1105: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1106: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1107: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1108: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

Page 1109: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

Page 1110: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

Page 1111: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1112: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1113: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1114: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

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50.000 % discount.

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50.000 % discount.

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50.000 % discount.

50.000 % discount.

50.000 % discount.

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50.000 % discount.

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50.000 % discount.

50.000 % discount.

50.000 % discount.

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50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1126: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

Page 1127: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

50.000 % discount.

50.000 % discount.

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50.000 % discount.

50.000 % discount.

50.000 % discount.

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THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

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50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1131: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1132: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO

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THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.

THE PROVIDERS INDIVIDUAL CONTRACT EXCLUDES BILLING FOR THIS PROCEDURE. THEREFORE, NO BALANCE DUE FROM THE PATIENT/PARTICIPANT.50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1134: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

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50.000 % discount.

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50.000 % discount.

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50.000 % discount.

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50.000 % discount.

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50.000 % discount.

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50.000 % discount.

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50.000 % discount.

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50.000 % discount.

50.000 % discount.

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50.000 % discount.

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50.000 % discount.

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50.000 % discount.

Page 1279: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

Page 1280: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1284: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

Page 1287: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1289: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1292: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1293: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 1294: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1295: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1296: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Please refer to Provider Contract for contracted rates/values.Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.

Please refer to Provider Contract for contracted rates/values.

Page 1297: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
Page 1298: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

Please refer to Provider Contract for contracted rates/values.

Page 1299: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1301: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

Page 1303: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

50.000 % discount.

50.000 % discount.

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50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1309: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

Page 1311: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

Page 1312: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1313: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

Page 1314: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1315: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1316: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

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50.000 % discount.

Page 1325: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1326: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1327: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1328: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

50.000 % discount.

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50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1333: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1334: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

Page 1335: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1336: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1342: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1344: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1345: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

Page 1346: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

Page 1347: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

Page 1348: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1349: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

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50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1351: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

Page 1352: 85004 Product Type: PPO · 2019. 9. 23. · Zip Code: 85004 Product Type: PPO CPF Sched ID: Date of Service: 06/22/2015 Service Code Modifier Allowed Amount Network Name A0021 5.91
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50.000 % discount.

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50.000 % discount.

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50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

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50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

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50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.

50.000 % discount.