A retrospective review was performed using the publicly available, national all-payer Mariner database (PearlDiver). All information was deidentified and U.S. Health Insurance Portability and Accountability Act (HIPAA)-compliant. The Mariner data set contains 122 million patients comprising commercial insurance, Medicare, Medicaid, government insurance, and cash payers from all U.S. states and territories. Research was performed using procedural and diagnosis codes from the International Classification of Diseases, Ninth Revision (ICD-9) and ICD, Tenth Revision (ICD-10), Current Procedural Terminology (CPT), and demographic, prescription, and physician specialty information. The data set contains claims from 2010 to 2019. Providers supplying claims are required to have annual, independent, third-party audits on validity and reliability of the data. Institutional review board approval was waived for this public database study.
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