CCN	Total IME Awarded	IME Effective 4/30/19	IME Effective 7/1/20	IME Effective 10/9/20	IME Effective As Needed	Total DGME Awarded	DGME Effective 4/30/19	DGME Effective 7/1/20	DGME Effective 10/9/20	DGME Effective As Needed	MAC			
090001	15.39	0.00	1.17	1.50	12.72	15.98	0.00	1.17	1.50	13.31	Novitas			
090004	9.92	2.39	0.00	0.00	7.53	10.44	2.39	0.00	0.00	8.05	Novitas			
090011	19.60	12.28	0.00	0.00	7.32	20.11	12.28	0.00	0.00	7.83	Novitas			
490063	5.60	0.00	0.00	0.00	5.60	5.60	0.00	0.00	0.00	5.60	Palmetto			
