2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0001 null revCode null united healthcare EPO I 11589.17 8691.88 8691.88 8691.88 6953.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0001 null revCode null united healthcare EPO O 17682.94 13621.21 13621.21 13621.21 10609.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0001 null revCode null united healthcare HMO I 11589.17 8691.88 8691.88 8691.88 6953.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0001 null revCode null united healthcare HMO O 17682.94 13621.21 13621.21 13621.21 10609.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0001 null revCode null united healthcare Medicaid I 11589.17 8691.88 8691.88 8691.88 6953.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0001 null revCode null united healthcare Medicaid O 17682.94 13621.21 13621.21 13621.21 10609.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0001 null revCode null united healthcare Medicare Part A I 11589.17 8691.88 8691.88 8691.88 6953.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0001 null revCode null united healthcare Medicare Part A O 17682.94 13621.21 13621.21 13621.21 10609.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0001 null revCode null united healthcare Medicare Part B I 11589.17 8691.88 8691.88 8691.88 6953.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0001 null revCode null united healthcare Medicare Part B O 17682.94 13621.21 13621.21 13621.21 10609.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0001 null revCode null united healthcare POS I 11589.17 8691.88 8691.88 8691.88 6953.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0001 null revCode null united healthcare POS O 17682.94 13621.21 13621.21 13621.21 10609.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0001 null revCode null united healthcare PPO I 11589.17 8691.88 8691.88 8691.88 6953.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0001 null revCode null united healthcare PPO O 17682.94 13621.21 13621.21 13621.21 10609.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0001 null revCode null united healthcare Workers Comp I 11589.17 8691.88 8691.88 8691.88 6953.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0001 null revCode null united healthcare Workers Comp O 17682.94 13621.21 13621.21 13621.21 10609.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures aetna - medicare advantage EPO I 378803.88 70257.44 108683.43 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures aetna - medicare advantage HMO I 378803.88 70257.44 108683.43 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures aetna - medicare advantage Medicaid I 378803.88 70257.44 108683.43 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures aetna - medicare advantage Medicare Part A I 378803.88 70257.44 108683.43 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures aetna - medicare advantage Medicare Part B I 378803.88 70257.44 108683.43 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures aetna - medicare advantage POS I 378803.88 70257.44 108683.43 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures aetna - medicare advantage PPO I 378803.88 70257.44 108683.43 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures aetna - medicare advantage Workers Comp I 378803.88 70257.44 108683.43 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures blue cross blue shield EPO I 378803.88 70257.44 148363.04 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures blue cross blue shield HMO I 378803.88 70257.44 148363.04 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures blue cross blue shield Medicaid I 378803.88 70257.44 148363.04 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures blue cross blue shield Medicare Part A I 378803.88 70257.44 148363.04 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures blue cross blue shield Medicare Part B I 378803.88 70257.44 148363.04 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures blue cross blue shield POS I 378803.88 70257.44 148363.04 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures blue cross blue shield PPO I 378803.88 70257.44 148363.04 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures blue cross blue shield Workers Comp I 378803.88 70257.44 148363.04 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures blue cross blue shield - medicare advantage EPO I 378803.88 70257.44 140121.38 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures blue cross blue shield - medicare advantage HMO I 378803.88 70257.44 140121.38 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures blue cross blue shield - medicare advantage Medicaid I 378803.88 70257.44 140121.38 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures blue cross blue shield - medicare advantage Medicare Part A I 378803.88 70257.44 140121.38 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures blue cross blue shield - medicare advantage Medicare Part B I 378803.88 70257.44 140121.38 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures blue cross blue shield - medicare advantage POS I 378803.88 70257.44 140121.38 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures blue cross blue shield - medicare advantage PPO I 378803.88 70257.44 140121.38 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures blue cross blue shield - medicare advantage Workers Comp I 378803.88 70257.44 140121.38 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures va EPO I 378803.88 70257.44 70257.44 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures va HMO I 378803.88 70257.44 70257.44 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures va Medicaid I 378803.88 70257.44 70257.44 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures va Medicare Part A I 378803.88 70257.44 70257.44 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures va Medicare Part B I 378803.88 70257.44 70257.44 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures va POS I 378803.88 70257.44 70257.44 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures va PPO I 378803.88 70257.44 70257.44 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 003 null ms-drg ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures va Workers Comp I 378803.88 70257.44 70257.44 148363.04 227282.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 004 null ms-drg tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures humana - medicare advantage EPO I 255142.72 60435.92 60435.92 87502.08 153085.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 004 null ms-drg tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures humana - medicare advantage HMO I 255142.72 60435.92 60435.92 87502.08 153085.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 004 null ms-drg tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures humana - medicare advantage Medicaid I 255142.72 60435.92 60435.92 87502.08 153085.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 004 null ms-drg tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures humana - medicare advantage Medicare Part A I 255142.72 60435.92 60435.92 87502.08 153085.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 004 null ms-drg tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures humana - medicare advantage Medicare Part B I 255142.72 60435.92 60435.92 87502.08 153085.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 004 null ms-drg tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures humana - medicare advantage POS I 255142.72 60435.92 60435.92 87502.08 153085.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 004 null ms-drg tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures humana - medicare advantage PPO I 255142.72 60435.92 60435.92 87502.08 153085.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 004 null ms-drg tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures humana - medicare advantage Workers Comp I 255142.72 60435.92 60435.92 87502.08 153085.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 004 null ms-drg tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures tricare EPO I 255142.72 60435.92 87502.08 87502.08 153085.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 004 null ms-drg tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures tricare HMO I 255142.72 60435.92 87502.08 87502.08 153085.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 004 null ms-drg tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures tricare Medicaid I 255142.72 60435.92 87502.08 87502.08 153085.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 004 null ms-drg tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures tricare Medicare Part A I 255142.72 60435.92 87502.08 87502.08 153085.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 004 null ms-drg tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures tricare Medicare Part B I 255142.72 60435.92 87502.08 87502.08 153085.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 004 null ms-drg tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures tricare POS I 255142.72 60435.92 87502.08 87502.08 153085.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 004 null ms-drg tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures tricare PPO I 255142.72 60435.92 87502.08 87502.08 153085.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 004 null ms-drg tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures tricare Workers Comp I 255142.72 60435.92 87502.08 87502.08 153085.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General aetna EPO I 1307.77 396.39 715.58 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General aetna HMO I 1307.77 396.39 715.58 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General aetna Medicaid I 1307.77 396.39 715.58 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General aetna Medicare Part A I 1307.77 396.39 715.58 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General aetna Medicare Part B I 1307.77 396.39 715.58 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General aetna POS I 1307.77 396.39 715.58 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General aetna PPO I 1307.77 396.39 715.58 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General aetna Workers Comp I 1307.77 396.39 715.58 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General aetna - medicare advantage EPO I 1307.77 396.39 897.73 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General aetna - medicare advantage HMO I 1307.77 396.39 897.73 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General aetna - medicare advantage Medicaid I 1307.77 396.39 897.73 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General aetna - medicare advantage Medicare Part A I 1307.77 396.39 897.73 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General aetna - medicare advantage Medicare Part B I 1307.77 396.39 897.73 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General aetna - medicare advantage POS I 1307.77 396.39 897.73 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General aetna - medicare advantage PPO I 1307.77 396.39 897.73 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General aetna - medicare advantage Workers Comp I 1307.77 396.39 897.73 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General cigna EPO I 1307.77 396.39 772.62 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General cigna HMO I 1307.77 396.39 772.62 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General cigna Medicaid I 1307.77 396.39 772.62 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General cigna Medicare Part A I 1307.77 396.39 772.62 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General cigna Medicare Part B I 1307.77 396.39 772.62 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General cigna POS I 1307.77 396.39 772.62 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General cigna PPO I 1307.77 396.39 772.62 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General cigna Workers Comp I 1307.77 396.39 772.62 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General united healthcare EPO I 1307.77 396.39 790.02 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General united healthcare HMO I 1307.77 396.39 790.02 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General united healthcare Medicaid I 1307.77 396.39 790.02 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General united healthcare Medicare Part A I 1307.77 396.39 790.02 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General united healthcare Medicare Part B I 1307.77 396.39 790.02 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General united healthcare POS I 1307.77 396.39 790.02 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General united healthcare PPO I 1307.77 396.39 790.02 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General united healthcare Workers Comp I 1307.77 396.39 790.02 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General united healthcare - medicare advantage EPO I 1307.77 396.39 546.92 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General united healthcare - medicare advantage HMO I 1307.77 396.39 546.92 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General united healthcare - medicare advantage Medicaid I 1307.77 396.39 546.92 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General united healthcare - medicare advantage Medicare Part A I 1307.77 396.39 546.92 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General united healthcare - medicare advantage Medicare Part B I 1307.77 396.39 546.92 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General united healthcare - medicare advantage POS I 1307.77 396.39 546.92 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General united healthcare - medicare advantage PPO I 1307.77 396.39 546.92 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General united healthcare - medicare advantage Workers Comp I 1307.77 396.39 546.92 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General va EPO I 1307.77 396.39 396.39 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General va HMO I 1307.77 396.39 396.39 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General va Medicaid I 1307.77 396.39 396.39 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General va Medicare Part A I 1307.77 396.39 396.39 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General va Medicare Part B I 1307.77 396.39 396.39 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General va POS I 1307.77 396.39 396.39 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General va PPO I 1307.77 396.39 396.39 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General va Workers Comp I 1307.77 396.39 396.39 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General webtpa EPO I 1307.77 396.39 3754.79 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General webtpa HMO I 1307.77 396.39 3754.79 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General webtpa Medicaid I 1307.77 396.39 3754.79 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General webtpa Medicare Part A I 1307.77 396.39 3754.79 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General webtpa Medicare Part B I 1307.77 396.39 3754.79 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General webtpa POS I 1307.77 396.39 3754.79 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General webtpa PPO I 1307.77 396.39 3754.79 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General webtpa Workers Comp I 1307.77 396.39 3754.79 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General webtpa - medicare advantage EPO I 1307.77 396.39 10261.86 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General webtpa - medicare advantage HMO I 1307.77 396.39 10261.86 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General webtpa - medicare advantage Medicaid I 1307.77 396.39 10261.86 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General webtpa - medicare advantage Medicare Part A I 1307.77 396.39 10261.86 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General webtpa - medicare advantage Medicare Part B I 1307.77 396.39 10261.86 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General webtpa - medicare advantage POS I 1307.77 396.39 10261.86 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General webtpa - medicare advantage PPO I 1307.77 396.39 10261.86 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0110 null revCode Room and Board Private (one bed) General webtpa - medicare advantage Workers Comp I 1307.77 396.39 10261.86 10261.86 784.66 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric aetna EPO I 2075.74 506.01 1203.93 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric aetna HMO I 2075.74 506.01 1203.93 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric aetna Medicaid I 2075.74 506.01 1203.93 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric aetna Medicare Part A I 2075.74 506.01 1203.93 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric aetna Medicare Part B I 2075.74 506.01 1203.93 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric aetna POS I 2075.74 506.01 1203.93 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric aetna PPO I 2075.74 506.01 1203.93 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric aetna Workers Comp I 2075.74 506.01 1203.93 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric va EPO I 2075.74 506.01 506.01 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric va HMO I 2075.74 506.01 506.01 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric va Medicaid I 2075.74 506.01 506.01 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric va Medicare Part A I 2075.74 506.01 506.01 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric va Medicare Part B I 2075.74 506.01 506.01 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric va POS I 2075.74 506.01 506.01 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric va PPO I 2075.74 506.01 506.01 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric va Workers Comp I 2075.74 506.01 506.01 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric webtpa EPO I 2075.74 506.01 1618.97 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric webtpa HMO I 2075.74 506.01 1618.97 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric webtpa Medicaid I 2075.74 506.01 1618.97 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric webtpa Medicare Part A I 2075.74 506.01 1618.97 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric webtpa Medicare Part B I 2075.74 506.01 1618.97 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric webtpa POS I 2075.74 506.01 1618.97 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric webtpa PPO I 2075.74 506.01 1618.97 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0114 null revCode Room and Board Private (one bed) Psychiatric webtpa Workers Comp I 2075.74 506.01 1618.97 1618.97 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0118 null revCode Room and Board Private (one bed) Rehabilitation webtpa EPO I 2675.11 1872.58 1872.58 1872.58 1605.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0118 null revCode Room and Board Private (one bed) Rehabilitation webtpa HMO I 2675.11 1872.58 1872.58 1872.58 1605.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0118 null revCode Room and Board Private (one bed) Rehabilitation webtpa Medicaid I 2675.11 1872.58 1872.58 1872.58 1605.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0118 null revCode Room and Board Private (one bed) Rehabilitation webtpa Medicare Part A I 2675.11 1872.58 1872.58 1872.58 1605.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0118 null revCode Room and Board Private (one bed) Rehabilitation webtpa Medicare Part B I 2675.11 1872.58 1872.58 1872.58 1605.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0118 null revCode Room and Board Private (one bed) Rehabilitation webtpa POS I 2675.11 1872.58 1872.58 1872.58 1605.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0118 null revCode Room and Board Private (one bed) Rehabilitation webtpa PPO I 2675.11 1872.58 1872.58 1872.58 1605.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0118 null revCode Room and Board Private (one bed) Rehabilitation webtpa Workers Comp I 2675.11 1872.58 1872.58 1872.58 1605.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General aetna EPO I 1233.75 337.83 685.16 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General aetna HMO I 1233.75 337.83 685.16 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General aetna Medicaid I 1233.75 337.83 685.16 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General aetna Medicare Part A I 1233.75 337.83 685.16 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General aetna Medicare Part B I 1233.75 337.83 685.16 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General aetna POS I 1233.75 337.83 685.16 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General aetna PPO I 1233.75 337.83 685.16 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General aetna Workers Comp I 1233.75 337.83 685.16 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General humana - medicare advantage EPO I 1233.75 337.83 1233.75 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General humana - medicare advantage HMO I 1233.75 337.83 1233.75 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General humana - medicare advantage Medicaid I 1233.75 337.83 1233.75 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General humana - medicare advantage Medicare Part A I 1233.75 337.83 1233.75 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General humana - medicare advantage Medicare Part B I 1233.75 337.83 1233.75 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General humana - medicare advantage POS I 1233.75 337.83 1233.75 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General humana - medicare advantage PPO I 1233.75 337.83 1233.75 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General humana - medicare advantage Workers Comp I 1233.75 337.83 1233.75 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General united healthcare EPO I 1233.75 337.83 706.75 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General united healthcare HMO I 1233.75 337.83 706.75 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General united healthcare Medicaid I 1233.75 337.83 706.75 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General united healthcare Medicare Part A I 1233.75 337.83 706.75 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General united healthcare Medicare Part B I 1233.75 337.83 706.75 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General united healthcare POS I 1233.75 337.83 706.75 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General united healthcare PPO I 1233.75 337.83 706.75 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General united healthcare Workers Comp I 1233.75 337.83 706.75 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General va EPO I 1233.75 337.83 337.83 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General va HMO I 1233.75 337.83 337.83 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General va Medicaid I 1233.75 337.83 337.83 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General va Medicare Part A I 1233.75 337.83 337.83 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General va Medicare Part B I 1233.75 337.83 337.83 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General va POS I 1233.75 337.83 337.83 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General va PPO I 1233.75 337.83 337.83 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0120 null revCode Room and Board Semiprivate (two beds) General va Workers Comp I 1233.75 337.83 337.83 1233.75 740.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0124 null revCode Room and Board Semiprivate (two beds) Psychiatric aetna EPO I 2075.74 734.76 734.76 849.40 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0124 null revCode Room and Board Semiprivate (two beds) Psychiatric aetna HMO I 2075.74 734.76 734.76 849.40 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0124 null revCode Room and Board Semiprivate (two beds) Psychiatric aetna Medicaid I 2075.74 734.76 734.76 849.40 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0124 null revCode Room and Board Semiprivate (two beds) Psychiatric aetna Medicare Part A I 2075.74 734.76 734.76 849.40 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0124 null revCode Room and Board Semiprivate (two beds) Psychiatric aetna Medicare Part B I 2075.74 734.76 734.76 849.40 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0124 null revCode Room and Board Semiprivate (two beds) Psychiatric aetna POS I 2075.74 734.76 734.76 849.40 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0124 null revCode Room and Board Semiprivate (two beds) Psychiatric aetna PPO I 2075.74 734.76 734.76 849.40 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0124 null revCode Room and Board Semiprivate (two beds) Psychiatric aetna Workers Comp I 2075.74 734.76 734.76 849.40 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0124 null revCode Room and Board Semiprivate (two beds) Psychiatric humana - medicare advantage EPO I 2075.74 734.76 849.40 849.40 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0124 null revCode Room and Board Semiprivate (two beds) Psychiatric humana - medicare advantage HMO I 2075.74 734.76 849.40 849.40 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0124 null revCode Room and Board Semiprivate (two beds) Psychiatric humana - medicare advantage Medicaid I 2075.74 734.76 849.40 849.40 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0124 null revCode Room and Board Semiprivate (two beds) Psychiatric humana - medicare advantage Medicare Part A I 2075.74 734.76 849.40 849.40 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0124 null revCode Room and Board Semiprivate (two beds) Psychiatric humana - medicare advantage Medicare Part B I 2075.74 734.76 849.40 849.40 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0124 null revCode Room and Board Semiprivate (two beds) Psychiatric humana - medicare advantage POS I 2075.74 734.76 849.40 849.40 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0124 null revCode Room and Board Semiprivate (two beds) Psychiatric humana - medicare advantage PPO I 2075.74 734.76 849.40 849.40 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0124 null revCode Room and Board Semiprivate (two beds) Psychiatric humana - medicare advantage Workers Comp I 2075.74 734.76 849.40 849.40 1245.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0128 null revCode Room and Board Semiprivate (two beds) Rehabilitation humana - medicare advantage EPO I 862.57 862.57 862.57 862.57 517.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0128 null revCode Room and Board Semiprivate (two beds) Rehabilitation humana - medicare advantage HMO I 862.57 862.57 862.57 862.57 517.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0128 null revCode Room and Board Semiprivate (two beds) Rehabilitation humana - medicare advantage Medicaid I 862.57 862.57 862.57 862.57 517.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0128 null revCode Room and Board Semiprivate (two beds) Rehabilitation humana - medicare advantage Medicare Part A I 862.57 862.57 862.57 862.57 517.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0128 null revCode Room and Board Semiprivate (two beds) Rehabilitation humana - medicare advantage Medicare Part B I 862.57 862.57 862.57 862.57 517.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0128 null revCode Room and Board Semiprivate (two beds) Rehabilitation humana - medicare advantage POS I 862.57 862.57 862.57 862.57 517.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0128 null revCode Room and Board Semiprivate (two beds) Rehabilitation humana - medicare advantage PPO I 862.57 862.57 862.57 862.57 517.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0128 null revCode Room and Board Semiprivate (two beds) Rehabilitation humana - medicare advantage Workers Comp I 862.57 862.57 862.57 862.57 517.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 01999 null cpt Anesthesia procedure tricare EPO O 20937.23 2683.82 2683.82 2683.82 12562.34 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 01999 null cpt Anesthesia procedure tricare HMO O 20937.23 2683.82 2683.82 2683.82 12562.34 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 01999 null cpt Anesthesia procedure tricare Medicaid O 20937.23 2683.82 2683.82 2683.82 12562.34 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 01999 null cpt Anesthesia procedure tricare Medicare Part A O 20937.23 2683.82 2683.82 2683.82 12562.34 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 01999 null cpt Anesthesia procedure tricare Medicare Part B O 20937.23 2683.82 2683.82 2683.82 12562.34 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 01999 null cpt Anesthesia procedure tricare POS O 20937.23 2683.82 2683.82 2683.82 12562.34 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 01999 null cpt Anesthesia procedure tricare PPO O 20937.23 2683.82 2683.82 2683.82 12562.34 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 01999 null cpt Anesthesia procedure tricare Workers Comp O 20937.23 2683.82 2683.82 2683.82 12562.34 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General aetna EPO I 5327.70 978.72 2573.10 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General aetna HMO I 5327.70 978.72 2573.10 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General aetna Medicaid I 5327.70 978.72 2573.10 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General aetna Medicare Part A I 5327.70 978.72 2573.10 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General aetna Medicare Part B I 5327.70 978.72 2573.10 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General aetna POS I 5327.70 978.72 2573.10 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General aetna PPO I 5327.70 978.72 2573.10 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General aetna Workers Comp I 5327.70 978.72 2573.10 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General aetna - medicare advantage EPO I 5327.70 978.72 3505.92 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General aetna - medicare advantage HMO I 5327.70 978.72 3505.92 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General aetna - medicare advantage Medicaid I 5327.70 978.72 3505.92 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General aetna - medicare advantage Medicare Part A I 5327.70 978.72 3505.92 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General aetna - medicare advantage Medicare Part B I 5327.70 978.72 3505.92 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General aetna - medicare advantage POS I 5327.70 978.72 3505.92 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General aetna - medicare advantage PPO I 5327.70 978.72 3505.92 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General aetna - medicare advantage Workers Comp I 5327.70 978.72 3505.92 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General cigna EPO I 5327.70 978.72 3951.05 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General cigna HMO I 5327.70 978.72 3951.05 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General cigna Medicaid I 5327.70 978.72 3951.05 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General cigna Medicare Part A I 5327.70 978.72 3951.05 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General cigna Medicare Part B I 5327.70 978.72 3951.05 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General cigna POS I 5327.70 978.72 3951.05 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General cigna PPO I 5327.70 978.72 3951.05 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General cigna Workers Comp I 5327.70 978.72 3951.05 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General humana - medicare advantage EPO I 5327.70 978.72 2404.81 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General humana - medicare advantage HMO I 5327.70 978.72 2404.81 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General humana - medicare advantage Medicaid I 5327.70 978.72 2404.81 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General humana - medicare advantage Medicare Part A I 5327.70 978.72 2404.81 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General humana - medicare advantage Medicare Part B I 5327.70 978.72 2404.81 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General humana - medicare advantage POS I 5327.70 978.72 2404.81 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General humana - medicare advantage PPO I 5327.70 978.72 2404.81 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General humana - medicare advantage Workers Comp I 5327.70 978.72 2404.81 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General united healthcare EPO I 5327.70 978.72 3400.22 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General united healthcare HMO I 5327.70 978.72 3400.22 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General united healthcare Medicaid I 5327.70 978.72 3400.22 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General united healthcare Medicare Part A I 5327.70 978.72 3400.22 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General united healthcare Medicare Part B I 5327.70 978.72 3400.22 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General united healthcare POS I 5327.70 978.72 3400.22 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General united healthcare PPO I 5327.70 978.72 3400.22 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General united healthcare Workers Comp I 5327.70 978.72 3400.22 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General va EPO I 5327.70 978.72 978.72 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General va HMO I 5327.70 978.72 978.72 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General va Medicaid I 5327.70 978.72 978.72 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General va Medicare Part A I 5327.70 978.72 978.72 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General va Medicare Part B I 5327.70 978.72 978.72 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General va POS I 5327.70 978.72 978.72 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General va PPO I 5327.70 978.72 978.72 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General va Workers Comp I 5327.70 978.72 978.72 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General webtpa EPO I 5327.70 978.72 5468.45 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General webtpa HMO I 5327.70 978.72 5468.45 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General webtpa Medicaid I 5327.70 978.72 5468.45 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General webtpa Medicare Part A I 5327.70 978.72 5468.45 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General webtpa Medicare Part B I 5327.70 978.72 5468.45 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General webtpa POS I 5327.70 978.72 5468.45 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General webtpa PPO I 5327.70 978.72 5468.45 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General webtpa Workers Comp I 5327.70 978.72 5468.45 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General worker comp EPO I 5327.70 978.72 4533.62 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General worker comp HMO I 5327.70 978.72 4533.62 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General worker comp Medicaid I 5327.70 978.72 4533.62 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General worker comp Medicare Part A I 5327.70 978.72 4533.62 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General worker comp Medicare Part B I 5327.70 978.72 4533.62 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General worker comp POS I 5327.70 978.72 4533.62 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General worker comp PPO I 5327.70 978.72 4533.62 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0200 null revCode Intensive Care Unit General worker comp Workers Comp I 5327.70 978.72 4533.62 5468.45 3196.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0210 null revCode Coronary Care Unit General humana - medicare advantage EPO I 3870.06 587.28 587.28 2902.55 2322.04 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0210 null revCode Coronary Care Unit General humana - medicare advantage HMO I 3870.06 587.28 587.28 2902.55 2322.04 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0210 null revCode Coronary Care Unit General humana - medicare advantage Medicaid I 3870.06 587.28 587.28 2902.55 2322.04 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0210 null revCode Coronary Care Unit General humana - medicare advantage Medicare Part A I 3870.06 587.28 587.28 2902.55 2322.04 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0210 null revCode Coronary Care Unit General humana - medicare advantage Medicare Part B I 3870.06 587.28 587.28 2902.55 2322.04 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0210 null revCode Coronary Care Unit General humana - medicare advantage POS I 3870.06 587.28 587.28 2902.55 2322.04 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0210 null revCode Coronary Care Unit General humana - medicare advantage PPO I 3870.06 587.28 587.28 2902.55 2322.04 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0210 null revCode Coronary Care Unit General humana - medicare advantage Workers Comp I 3870.06 587.28 587.28 2902.55 2322.04 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0210 null revCode Coronary Care Unit General united healthcare EPO I 3870.06 587.28 2902.55 2902.55 2322.04 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0210 null revCode Coronary Care Unit General united healthcare HMO I 3870.06 587.28 2902.55 2902.55 2322.04 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0210 null revCode Coronary Care Unit General united healthcare Medicaid I 3870.06 587.28 2902.55 2902.55 2322.04 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0210 null revCode Coronary Care Unit General united healthcare Medicare Part A I 3870.06 587.28 2902.55 2902.55 2322.04 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0210 null revCode Coronary Care Unit General united healthcare Medicare Part B I 3870.06 587.28 2902.55 2902.55 2322.04 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0210 null revCode Coronary Care Unit General united healthcare POS I 3870.06 587.28 2902.55 2902.55 2322.04 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0210 null revCode Coronary Care Unit General united healthcare PPO I 3870.06 587.28 2902.55 2902.55 2322.04 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0210 null revCode Coronary Care Unit General united healthcare Workers Comp I 3870.06 587.28 2902.55 2902.55 2322.04 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU aetna EPO I 3696.00 872.43 1727.67 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU aetna HMO I 3696.00 872.43 1727.67 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU aetna Medicaid I 3696.00 872.43 1727.67 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU aetna Medicare Part A I 3696.00 872.43 1727.67 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU aetna Medicare Part B I 3696.00 872.43 1727.67 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU aetna POS I 3696.00 872.43 1727.67 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU aetna PPO I 3696.00 872.43 1727.67 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU aetna Workers Comp I 3696.00 872.43 1727.67 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU aetna - medicare advantage EPO I 3696.00 872.43 1965.76 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU aetna - medicare advantage HMO I 3696.00 872.43 1965.76 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU aetna - medicare advantage Medicaid I 3696.00 872.43 1965.76 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU aetna - medicare advantage Medicare Part A I 3696.00 872.43 1965.76 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU aetna - medicare advantage Medicare Part B I 3696.00 872.43 1965.76 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU aetna - medicare advantage POS I 3696.00 872.43 1965.76 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU aetna - medicare advantage PPO I 3696.00 872.43 1965.76 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU aetna - medicare advantage Workers Comp I 3696.00 872.43 1965.76 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU cigna EPO I 3696.00 872.43 2214.67 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU cigna HMO I 3696.00 872.43 2214.67 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU cigna Medicaid I 3696.00 872.43 2214.67 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU cigna Medicare Part A I 3696.00 872.43 2214.67 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU cigna Medicare Part B I 3696.00 872.43 2214.67 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU cigna POS I 3696.00 872.43 2214.67 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU cigna PPO I 3696.00 872.43 2214.67 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU cigna Workers Comp I 3696.00 872.43 2214.67 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU humana - medicare advantage EPO I 3696.00 872.43 1895.12 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU humana - medicare advantage HMO I 3696.00 872.43 1895.12 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU humana - medicare advantage Medicaid I 3696.00 872.43 1895.12 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU humana - medicare advantage Medicare Part A I 3696.00 872.43 1895.12 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU humana - medicare advantage Medicare Part B I 3696.00 872.43 1895.12 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU humana - medicare advantage POS I 3696.00 872.43 1895.12 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU humana - medicare advantage PPO I 3696.00 872.43 1895.12 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU humana - medicare advantage Workers Comp I 3696.00 872.43 1895.12 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU united healthcare EPO I 3696.00 872.43 2138.15 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU united healthcare HMO I 3696.00 872.43 2138.15 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU united healthcare Medicaid I 3696.00 872.43 2138.15 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU united healthcare Medicare Part A I 3696.00 872.43 2138.15 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU united healthcare Medicare Part B I 3696.00 872.43 2138.15 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU united healthcare POS I 3696.00 872.43 2138.15 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU united healthcare PPO I 3696.00 872.43 2138.15 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU united healthcare Workers Comp I 3696.00 872.43 2138.15 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU united healthcare - medicare advantage EPO I 3696.00 872.43 1039.65 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU united healthcare - medicare advantage HMO I 3696.00 872.43 1039.65 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU united healthcare - medicare advantage Medicaid I 3696.00 872.43 1039.65 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU united healthcare - medicare advantage Medicare Part A I 3696.00 872.43 1039.65 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU united healthcare - medicare advantage Medicare Part B I 3696.00 872.43 1039.65 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU united healthcare - medicare advantage POS I 3696.00 872.43 1039.65 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU united healthcare - medicare advantage PPO I 3696.00 872.43 1039.65 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU united healthcare - medicare advantage Workers Comp I 3696.00 872.43 1039.65 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU va EPO I 3696.00 872.43 872.43 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU va HMO I 3696.00 872.43 872.43 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU va Medicaid I 3696.00 872.43 872.43 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU va Medicare Part A I 3696.00 872.43 872.43 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU va Medicare Part B I 3696.00 872.43 872.43 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU va POS I 3696.00 872.43 872.43 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU va PPO I 3696.00 872.43 872.43 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU va Workers Comp I 3696.00 872.43 872.43 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU webtpa EPO I 3696.00 872.43 11321.78 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU webtpa HMO I 3696.00 872.43 11321.78 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU webtpa Medicaid I 3696.00 872.43 11321.78 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU webtpa Medicare Part A I 3696.00 872.43 11321.78 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU webtpa Medicare Part B I 3696.00 872.43 11321.78 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU webtpa POS I 3696.00 872.43 11321.78 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU webtpa PPO I 3696.00 872.43 11321.78 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU webtpa Workers Comp I 3696.00 872.43 11321.78 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU worker comp EPO I 3696.00 872.43 2235.54 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU worker comp HMO I 3696.00 872.43 2235.54 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU worker comp Medicaid I 3696.00 872.43 2235.54 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU worker comp Medicare Part A I 3696.00 872.43 2235.54 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU worker comp Medicare Part B I 3696.00 872.43 2235.54 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU worker comp POS I 3696.00 872.43 2235.54 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU worker comp PPO I 3696.00 872.43 2235.54 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0214 null revCode Coronary Care Unit Intermediate CCU worker comp Workers Comp I 3696.00 872.43 2235.54 11321.78 2217.60 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc blue cross blue shield EPO I 91639.97 25891.77 38716.69 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc blue cross blue shield HMO I 91639.97 25891.77 38716.69 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc blue cross blue shield Medicaid I 91639.97 25891.77 38716.69 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc blue cross blue shield Medicare Part A I 91639.97 25891.77 38716.69 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc blue cross blue shield Medicare Part B I 91639.97 25891.77 38716.69 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc blue cross blue shield POS I 91639.97 25891.77 38716.69 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc blue cross blue shield PPO I 91639.97 25891.77 38716.69 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc blue cross blue shield Workers Comp I 91639.97 25891.77 38716.69 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc humana - medicare advantage EPO I 91639.97 25891.77 25891.77 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc humana - medicare advantage HMO I 91639.97 25891.77 25891.77 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc humana - medicare advantage Medicaid I 91639.97 25891.77 25891.77 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc humana - medicare advantage Medicare Part A I 91639.97 25891.77 25891.77 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc humana - medicare advantage Medicare Part B I 91639.97 25891.77 25891.77 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc humana - medicare advantage POS I 91639.97 25891.77 25891.77 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc humana - medicare advantage PPO I 91639.97 25891.77 25891.77 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc humana - medicare advantage Workers Comp I 91639.97 25891.77 25891.77 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc tricare EPO I 91639.97 25891.77 27959.42 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc tricare HMO I 91639.97 25891.77 27959.42 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc tricare Medicaid I 91639.97 25891.77 27959.42 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc tricare Medicare Part A I 91639.97 25891.77 27959.42 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc tricare Medicare Part B I 91639.97 25891.77 27959.42 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc tricare POS I 91639.97 25891.77 27959.42 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc tricare PPO I 91639.97 25891.77 27959.42 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 025 null ms-drg craniotomy and endovascular intracranial procedures with mcc tricare Workers Comp I 91639.97 25891.77 27959.42 38716.69 54983.98 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General aetna EPO I 9.63 2.41 8.12 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General aetna EPO O 12.21 0.63 5.21 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General aetna HMO I 9.63 2.41 8.12 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General aetna HMO O 12.21 0.63 5.21 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General aetna Medicaid I 9.63 2.41 8.12 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General aetna Medicaid O 12.21 0.63 5.21 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General aetna Medicare Part A I 9.63 2.41 8.12 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General aetna Medicare Part A O 12.21 0.63 5.21 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General aetna Medicare Part B I 9.63 2.41 8.12 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General aetna Medicare Part B O 12.21 0.63 5.21 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General aetna POS I 9.63 2.41 8.12 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General aetna POS O 12.21 0.63 5.21 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General aetna PPO I 9.63 2.41 8.12 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General aetna PPO O 12.21 0.63 5.21 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General aetna Workers Comp I 9.63 2.41 8.12 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General aetna Workers Comp O 12.21 0.63 5.21 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General blue cross blue shield EPO O 12.21 0.63 4.35 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General blue cross blue shield HMO O 12.21 0.63 4.35 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General blue cross blue shield Medicaid O 12.21 0.63 4.35 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General blue cross blue shield Medicare Part A O 12.21 0.63 4.35 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General blue cross blue shield Medicare Part B O 12.21 0.63 4.35 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General blue cross blue shield POS O 12.21 0.63 4.35 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General blue cross blue shield PPO O 12.21 0.63 4.35 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General blue cross blue shield Workers Comp O 12.21 0.63 4.35 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General blue cross blue shield - medicare advantage EPO O 12.21 0.63 4.39 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General blue cross blue shield - medicare advantage HMO O 12.21 0.63 4.39 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General blue cross blue shield - medicare advantage Medicaid O 12.21 0.63 4.39 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General blue cross blue shield - medicare advantage Medicare Part A O 12.21 0.63 4.39 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General blue cross blue shield - medicare advantage Medicare Part B O 12.21 0.63 4.39 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General blue cross blue shield - medicare advantage POS O 12.21 0.63 4.39 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General blue cross blue shield - medicare advantage PPO O 12.21 0.63 4.39 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General blue cross blue shield - medicare advantage Workers Comp O 12.21 0.63 4.39 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General cigna EPO I 9.63 2.41 8.35 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General cigna EPO O 12.21 0.63 21.36 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General cigna HMO I 9.63 2.41 8.35 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General cigna HMO O 12.21 0.63 21.36 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General cigna Medicaid I 9.63 2.41 8.35 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General cigna Medicaid O 12.21 0.63 21.36 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General cigna Medicare Part A I 9.63 2.41 8.35 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General cigna Medicare Part A O 12.21 0.63 21.36 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General cigna Medicare Part B I 9.63 2.41 8.35 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General cigna Medicare Part B O 12.21 0.63 21.36 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General cigna POS I 9.63 2.41 8.35 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General cigna POS O 12.21 0.63 21.36 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General cigna PPO I 9.63 2.41 8.35 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General cigna PPO O 12.21 0.63 21.36 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General cigna Workers Comp I 9.63 2.41 8.35 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General cigna Workers Comp O 12.21 0.63 21.36 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General geha EPO O 12.21 0.63 29.18 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General geha HMO O 12.21 0.63 29.18 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General geha Medicaid O 12.21 0.63 29.18 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General geha Medicare Part A O 12.21 0.63 29.18 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General geha Medicare Part B O 12.21 0.63 29.18 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General geha POS O 12.21 0.63 29.18 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General geha PPO O 12.21 0.63 29.18 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General geha Workers Comp O 12.21 0.63 29.18 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General healthchoice EPO O 12.21 0.63 0.63 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General healthchoice HMO O 12.21 0.63 0.63 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General healthchoice Medicaid O 12.21 0.63 0.63 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General healthchoice Medicare Part A O 12.21 0.63 0.63 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General healthchoice Medicare Part B O 12.21 0.63 0.63 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General healthchoice POS O 12.21 0.63 0.63 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General healthchoice PPO O 12.21 0.63 0.63 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General healthchoice Workers Comp O 12.21 0.63 0.63 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General humana - medicare advantage EPO I 9.63 2.41 10.52 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General humana - medicare advantage EPO O 12.21 0.63 68.02 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General humana - medicare advantage HMO I 9.63 2.41 10.52 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General humana - medicare advantage HMO O 12.21 0.63 68.02 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General humana - medicare advantage Medicaid I 9.63 2.41 10.52 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General humana - medicare advantage Medicaid O 12.21 0.63 68.02 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General humana - medicare advantage Medicare Part A I 9.63 2.41 10.52 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General humana - medicare advantage Medicare Part A O 12.21 0.63 68.02 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General humana - medicare advantage Medicare Part B I 9.63 2.41 10.52 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General humana - medicare advantage Medicare Part B O 12.21 0.63 68.02 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General humana - medicare advantage POS I 9.63 2.41 10.52 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General humana - medicare advantage POS O 12.21 0.63 68.02 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General humana - medicare advantage PPO I 9.63 2.41 10.52 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General humana - medicare advantage PPO O 12.21 0.63 68.02 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General humana - medicare advantage Workers Comp I 9.63 2.41 10.52 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General humana - medicare advantage Workers Comp O 12.21 0.63 68.02 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General medica EPO O 12.21 0.63 3.26 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General medica HMO O 12.21 0.63 3.26 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General medica Medicaid O 12.21 0.63 3.26 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General medica Medicare Part A O 12.21 0.63 3.26 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General medica Medicare Part B O 12.21 0.63 3.26 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General medica POS O 12.21 0.63 3.26 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General medica PPO O 12.21 0.63 3.26 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General medica Workers Comp O 12.21 0.63 3.26 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General united healthcare EPO I 9.63 2.41 9.04 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General united healthcare EPO O 12.21 0.63 29.11 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General united healthcare HMO I 9.63 2.41 9.04 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General united healthcare HMO O 12.21 0.63 29.11 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General united healthcare Medicaid I 9.63 2.41 9.04 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General united healthcare Medicaid O 12.21 0.63 29.11 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General united healthcare Medicare Part A I 9.63 2.41 9.04 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General united healthcare Medicare Part A O 12.21 0.63 29.11 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General united healthcare Medicare Part B I 9.63 2.41 9.04 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General united healthcare Medicare Part B O 12.21 0.63 29.11 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General united healthcare POS I 9.63 2.41 9.04 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General united healthcare POS O 12.21 0.63 29.11 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General united healthcare PPO I 9.63 2.41 9.04 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General united healthcare PPO O 12.21 0.63 29.11 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General united healthcare Workers Comp I 9.63 2.41 9.04 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General united healthcare Workers Comp O 12.21 0.63 29.11 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General va EPO I 9.63 2.41 2.41 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General va EPO O 12.21 0.63 24.22 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General va HMO I 9.63 2.41 2.41 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General va HMO O 12.21 0.63 24.22 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General va Medicaid I 9.63 2.41 2.41 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General va Medicaid O 12.21 0.63 24.22 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General va Medicare Part A I 9.63 2.41 2.41 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General va Medicare Part A O 12.21 0.63 24.22 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General va Medicare Part B I 9.63 2.41 2.41 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General va Medicare Part B O 12.21 0.63 24.22 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General va POS I 9.63 2.41 2.41 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General va POS O 12.21 0.63 24.22 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General va PPO I 9.63 2.41 2.41 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General va PPO O 12.21 0.63 24.22 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General va Workers Comp I 9.63 2.41 2.41 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General va Workers Comp O 12.21 0.63 24.22 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General webtpa EPO O 12.21 0.63 156.54 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General webtpa HMO O 12.21 0.63 156.54 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General webtpa Medicaid O 12.21 0.63 156.54 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General webtpa Medicare Part A O 12.21 0.63 156.54 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General webtpa Medicare Part B O 12.21 0.63 156.54 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General webtpa POS O 12.21 0.63 156.54 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General webtpa PPO O 12.21 0.63 156.54 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General webtpa Workers Comp O 12.21 0.63 156.54 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General worker comp EPO I 9.63 2.41 10.93 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General worker comp EPO O 12.21 0.63 22.84 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General worker comp HMO I 9.63 2.41 10.93 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General worker comp HMO O 12.21 0.63 22.84 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General worker comp Medicaid I 9.63 2.41 10.93 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General worker comp Medicaid O 12.21 0.63 22.84 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General worker comp Medicare Part A I 9.63 2.41 10.93 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General worker comp Medicare Part A O 12.21 0.63 22.84 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General worker comp Medicare Part B I 9.63 2.41 10.93 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General worker comp Medicare Part B O 12.21 0.63 22.84 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General worker comp POS I 9.63 2.41 10.93 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General worker comp POS O 12.21 0.63 22.84 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General worker comp PPO I 9.63 2.41 10.93 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General worker comp PPO O 12.21 0.63 22.84 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General worker comp Workers Comp I 9.63 2.41 10.93 10.93 5.78 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0250 null revCode Pharmacy General worker comp Workers Comp O 12.21 0.63 22.84 156.54 7.33 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions aetna EPO I 135.76 30.68 63.00 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions aetna EPO O 105.71 1.75 21.58 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions aetna HMO I 135.76 30.68 63.00 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions aetna HMO O 105.71 1.75 21.58 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions aetna Medicaid I 135.76 30.68 63.00 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions aetna Medicaid O 105.71 1.75 21.58 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions aetna Medicare Part A I 135.76 30.68 63.00 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions aetna Medicare Part A O 105.71 1.75 21.58 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions aetna Medicare Part B I 135.76 30.68 63.00 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions aetna Medicare Part B O 105.71 1.75 21.58 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions aetna POS I 135.76 30.68 63.00 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions aetna POS O 105.71 1.75 21.58 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions aetna PPO I 135.76 30.68 63.00 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions aetna PPO O 105.71 1.75 21.58 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions aetna Workers Comp I 135.76 30.68 63.00 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions aetna Workers Comp O 105.71 1.75 21.58 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions blue cross blue shield EPO O 105.71 1.75 15.17 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions blue cross blue shield HMO O 105.71 1.75 15.17 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions blue cross blue shield Medicaid O 105.71 1.75 15.17 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions blue cross blue shield Medicare Part A O 105.71 1.75 15.17 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions blue cross blue shield Medicare Part B O 105.71 1.75 15.17 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions blue cross blue shield POS O 105.71 1.75 15.17 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions blue cross blue shield PPO O 105.71 1.75 15.17 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions blue cross blue shield Workers Comp O 105.71 1.75 15.17 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions blue cross blue shield - medicare advantage EPO O 105.71 1.75 23.84 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions blue cross blue shield - medicare advantage HMO O 105.71 1.75 23.84 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions blue cross blue shield - medicare advantage Medicaid O 105.71 1.75 23.84 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions blue cross blue shield - medicare advantage Medicare Part A O 105.71 1.75 23.84 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions blue cross blue shield - medicare advantage Medicare Part B O 105.71 1.75 23.84 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions blue cross blue shield - medicare advantage POS O 105.71 1.75 23.84 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions blue cross blue shield - medicare advantage PPO O 105.71 1.75 23.84 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions blue cross blue shield - medicare advantage Workers Comp O 105.71 1.75 23.84 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions cigna EPO I 135.76 30.68 118.12 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions cigna EPO O 105.71 1.75 78.55 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions cigna HMO I 135.76 30.68 118.12 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions cigna HMO O 105.71 1.75 78.55 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions cigna Medicaid I 135.76 30.68 118.12 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions cigna Medicaid O 105.71 1.75 78.55 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions cigna Medicare Part A I 135.76 30.68 118.12 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions cigna Medicare Part A O 105.71 1.75 78.55 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions cigna Medicare Part B I 135.76 30.68 118.12 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions cigna Medicare Part B O 105.71 1.75 78.55 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions cigna POS I 135.76 30.68 118.12 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions cigna POS O 105.71 1.75 78.55 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions cigna PPO I 135.76 30.68 118.12 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions cigna PPO O 105.71 1.75 78.55 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions cigna Workers Comp I 135.76 30.68 118.12 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions cigna Workers Comp O 105.71 1.75 78.55 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions geha EPO O 105.71 1.75 44.30 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions geha HMO O 105.71 1.75 44.30 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions geha Medicaid O 105.71 1.75 44.30 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions geha Medicare Part A O 105.71 1.75 44.30 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions geha Medicare Part B O 105.71 1.75 44.30 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions geha POS O 105.71 1.75 44.30 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions geha PPO O 105.71 1.75 44.30 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions geha Workers Comp O 105.71 1.75 44.30 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions healthchoice EPO O 105.71 1.75 1.75 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions healthchoice HMO O 105.71 1.75 1.75 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions healthchoice Medicaid O 105.71 1.75 1.75 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions healthchoice Medicare Part A O 105.71 1.75 1.75 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions healthchoice Medicare Part B O 105.71 1.75 1.75 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions healthchoice POS O 105.71 1.75 1.75 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions healthchoice PPO O 105.71 1.75 1.75 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions healthchoice Workers Comp O 105.71 1.75 1.75 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions humana - medicare advantage EPO I 135.76 30.68 118.28 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions humana - medicare advantage EPO O 105.71 1.75 103.83 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions humana - medicare advantage HMO I 135.76 30.68 118.28 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions humana - medicare advantage HMO O 105.71 1.75 103.83 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions humana - medicare advantage Medicaid I 135.76 30.68 118.28 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions humana - medicare advantage Medicaid O 105.71 1.75 103.83 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions humana - medicare advantage Medicare Part A I 135.76 30.68 118.28 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions humana - medicare advantage Medicare Part A O 105.71 1.75 103.83 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions humana - medicare advantage Medicare Part B I 135.76 30.68 118.28 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions humana - medicare advantage Medicare Part B O 105.71 1.75 103.83 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions humana - medicare advantage POS I 135.76 30.68 118.28 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions humana - medicare advantage POS O 105.71 1.75 103.83 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions humana - medicare advantage PPO I 135.76 30.68 118.28 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions humana - medicare advantage PPO O 105.71 1.75 103.83 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions humana - medicare advantage Workers Comp I 135.76 30.68 118.28 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions humana - medicare advantage Workers Comp O 105.71 1.75 103.83 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions medica EPO O 105.71 1.75 4.82 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions medica HMO O 105.71 1.75 4.82 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions medica Medicaid O 105.71 1.75 4.82 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions medica Medicare Part A O 105.71 1.75 4.82 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions medica Medicare Part B O 105.71 1.75 4.82 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions medica POS O 105.71 1.75 4.82 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions medica PPO O 105.71 1.75 4.82 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions medica Workers Comp O 105.71 1.75 4.82 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions united healthcare EPO O 105.71 1.75 78.61 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions united healthcare HMO O 105.71 1.75 78.61 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions united healthcare Medicaid O 105.71 1.75 78.61 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions united healthcare Medicare Part A O 105.71 1.75 78.61 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions united healthcare Medicare Part B O 105.71 1.75 78.61 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions united healthcare POS O 105.71 1.75 78.61 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions united healthcare PPO O 105.71 1.75 78.61 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions united healthcare Workers Comp O 105.71 1.75 78.61 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions va EPO I 135.76 30.68 30.68 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions va EPO O 105.71 1.75 12.40 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions va HMO I 135.76 30.68 30.68 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions va HMO O 105.71 1.75 12.40 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions va Medicaid I 135.76 30.68 30.68 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions va Medicaid O 105.71 1.75 12.40 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions va Medicare Part A I 135.76 30.68 30.68 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions va Medicare Part A O 105.71 1.75 12.40 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions va Medicare Part B I 135.76 30.68 30.68 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions va Medicare Part B O 105.71 1.75 12.40 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions va POS I 135.76 30.68 30.68 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions va POS O 105.71 1.75 12.40 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions va PPO I 135.76 30.68 30.68 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions va PPO O 105.71 1.75 12.40 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions va Workers Comp I 135.76 30.68 30.68 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions va Workers Comp O 105.71 1.75 12.40 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions worker comp EPO I 135.76 30.68 162.00 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions worker comp EPO O 105.71 1.75 80.14 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions worker comp HMO I 135.76 30.68 162.00 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions worker comp HMO O 105.71 1.75 80.14 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions worker comp Medicaid I 135.76 30.68 162.00 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions worker comp Medicaid O 105.71 1.75 80.14 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions worker comp Medicare Part A I 135.76 30.68 162.00 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions worker comp Medicare Part A O 105.71 1.75 80.14 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions worker comp Medicare Part B I 135.76 30.68 162.00 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions worker comp Medicare Part B O 105.71 1.75 80.14 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions worker comp POS I 135.76 30.68 162.00 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions worker comp POS O 105.71 1.75 80.14 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions worker comp PPO I 135.76 30.68 162.00 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions worker comp PPO O 105.71 1.75 80.14 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions worker comp Workers Comp I 135.76 30.68 162.00 162.00 81.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0258 null revCode Pharmacy IVsolutions worker comp Workers Comp O 105.71 1.75 80.14 103.83 63.43 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General aetna EPO O 307.18 65.78 178.16 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General aetna HMO O 307.18 65.78 178.16 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General aetna Medicaid O 307.18 65.78 178.16 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General aetna Medicare Part A O 307.18 65.78 178.16 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General aetna Medicare Part B O 307.18 65.78 178.16 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General aetna POS O 307.18 65.78 178.16 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General aetna PPO O 307.18 65.78 178.16 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General aetna Workers Comp O 307.18 65.78 178.16 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General blue cross blue shield EPO O 307.18 65.78 139.89 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General blue cross blue shield HMO O 307.18 65.78 139.89 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General blue cross blue shield Medicaid O 307.18 65.78 139.89 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General blue cross blue shield Medicare Part A O 307.18 65.78 139.89 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General blue cross blue shield Medicare Part B O 307.18 65.78 139.89 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General blue cross blue shield POS O 307.18 65.78 139.89 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General blue cross blue shield PPO O 307.18 65.78 139.89 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General blue cross blue shield Workers Comp O 307.18 65.78 139.89 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General blue cross blue shield - medicare advantage EPO O 307.18 65.78 75.73 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General blue cross blue shield - medicare advantage HMO O 307.18 65.78 75.73 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General blue cross blue shield - medicare advantage Medicaid O 307.18 65.78 75.73 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General blue cross blue shield - medicare advantage Medicare Part A O 307.18 65.78 75.73 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General blue cross blue shield - medicare advantage Medicare Part B O 307.18 65.78 75.73 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General blue cross blue shield - medicare advantage POS O 307.18 65.78 75.73 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General blue cross blue shield - medicare advantage PPO O 307.18 65.78 75.73 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General blue cross blue shield - medicare advantage Workers Comp O 307.18 65.78 75.73 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General cigna EPO O 307.18 65.78 205.08 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General cigna HMO O 307.18 65.78 205.08 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General cigna Medicaid O 307.18 65.78 205.08 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General cigna Medicare Part A O 307.18 65.78 205.08 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General cigna Medicare Part B O 307.18 65.78 205.08 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General cigna POS O 307.18 65.78 205.08 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General cigna PPO O 307.18 65.78 205.08 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General cigna Workers Comp O 307.18 65.78 205.08 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General humana - medicare advantage EPO I 907.09 907.09 907.09 907.09 544.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General humana - medicare advantage EPO O 307.18 65.78 162.77 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General humana - medicare advantage HMO I 907.09 907.09 907.09 907.09 544.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General humana - medicare advantage HMO O 307.18 65.78 162.77 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General humana - medicare advantage Medicaid I 907.09 907.09 907.09 907.09 544.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General humana - medicare advantage Medicaid O 307.18 65.78 162.77 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General humana - medicare advantage Medicare Part A I 907.09 907.09 907.09 907.09 544.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General humana - medicare advantage Medicare Part A O 307.18 65.78 162.77 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General humana - medicare advantage Medicare Part B I 907.09 907.09 907.09 907.09 544.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General humana - medicare advantage Medicare Part B O 307.18 65.78 162.77 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General humana - medicare advantage POS I 907.09 907.09 907.09 907.09 544.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General humana - medicare advantage POS O 307.18 65.78 162.77 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General humana - medicare advantage PPO I 907.09 907.09 907.09 907.09 544.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General humana - medicare advantage PPO O 307.18 65.78 162.77 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General humana - medicare advantage Workers Comp I 907.09 907.09 907.09 907.09 544.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General humana - medicare advantage Workers Comp O 307.18 65.78 162.77 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General tricare EPO O 307.18 65.78 162.77 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General tricare HMO O 307.18 65.78 162.77 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General tricare Medicaid O 307.18 65.78 162.77 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General tricare Medicare Part A O 307.18 65.78 162.77 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General tricare Medicare Part B O 307.18 65.78 162.77 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General tricare POS O 307.18 65.78 162.77 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General tricare PPO O 307.18 65.78 162.77 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General tricare Workers Comp O 307.18 65.78 162.77 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General va EPO O 307.18 65.78 65.78 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General va HMO O 307.18 65.78 65.78 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General va Medicaid O 307.18 65.78 65.78 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General va Medicare Part A O 307.18 65.78 65.78 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General va Medicare Part B O 307.18 65.78 65.78 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General va POS O 307.18 65.78 65.78 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General va PPO O 307.18 65.78 65.78 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0260 null revCode IVTherapy General va Workers Comp O 307.18 65.78 65.78 205.08 184.31 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna EPO I 70.37 18.60 124.91 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna EPO O 33.38 1.89 18.70 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna HMO I 70.37 18.60 124.91 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna HMO O 33.38 1.89 18.70 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna Medicaid I 70.37 18.60 124.91 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna Medicaid O 33.38 1.89 18.70 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna Medicare Part A I 70.37 18.60 124.91 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna Medicare Part A O 33.38 1.89 18.70 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna Medicare Part B I 70.37 18.60 124.91 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna Medicare Part B O 33.38 1.89 18.70 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna POS I 70.37 18.60 124.91 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna POS O 33.38 1.89 18.70 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna PPO I 70.37 18.60 124.91 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna PPO O 33.38 1.89 18.70 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna Workers Comp I 70.37 18.60 124.91 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna Workers Comp O 33.38 1.89 18.70 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna - medicare advantage EPO O 33.38 1.89 12.72 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna - medicare advantage HMO O 33.38 1.89 12.72 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna - medicare advantage Medicaid O 33.38 1.89 12.72 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna - medicare advantage Medicare Part A O 33.38 1.89 12.72 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna - medicare advantage Medicare Part B O 33.38 1.89 12.72 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna - medicare advantage POS O 33.38 1.89 12.72 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna - medicare advantage PPO O 33.38 1.89 12.72 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General aetna - medicare advantage Workers Comp O 33.38 1.89 12.72 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General blue cross blue shield EPO O 33.38 1.89 10.77 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General blue cross blue shield HMO O 33.38 1.89 10.77 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General blue cross blue shield Medicaid O 33.38 1.89 10.77 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General blue cross blue shield Medicare Part A O 33.38 1.89 10.77 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General blue cross blue shield Medicare Part B O 33.38 1.89 10.77 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General blue cross blue shield POS O 33.38 1.89 10.77 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General blue cross blue shield PPO O 33.38 1.89 10.77 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General blue cross blue shield Workers Comp O 33.38 1.89 10.77 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General blue cross blue shield - medicare advantage EPO O 33.38 1.89 10.14 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General blue cross blue shield - medicare advantage HMO O 33.38 1.89 10.14 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General blue cross blue shield - medicare advantage Medicaid O 33.38 1.89 10.14 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General blue cross blue shield - medicare advantage Medicare Part A O 33.38 1.89 10.14 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General blue cross blue shield - medicare advantage Medicare Part B O 33.38 1.89 10.14 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General blue cross blue shield - medicare advantage POS O 33.38 1.89 10.14 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General blue cross blue shield - medicare advantage PPO O 33.38 1.89 10.14 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General blue cross blue shield - medicare advantage Workers Comp O 33.38 1.89 10.14 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General cigna EPO I 70.37 18.60 39.89 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General cigna EPO O 33.38 1.89 27.86 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General cigna HMO I 70.37 18.60 39.89 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General cigna HMO O 33.38 1.89 27.86 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General cigna Medicaid I 70.37 18.60 39.89 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General cigna Medicaid O 33.38 1.89 27.86 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General cigna Medicare Part A I 70.37 18.60 39.89 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General cigna Medicare Part A O 33.38 1.89 27.86 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General cigna Medicare Part B I 70.37 18.60 39.89 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General cigna Medicare Part B O 33.38 1.89 27.86 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General cigna POS I 70.37 18.60 39.89 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General cigna POS O 33.38 1.89 27.86 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General cigna PPO I 70.37 18.60 39.89 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General cigna PPO O 33.38 1.89 27.86 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General cigna Workers Comp I 70.37 18.60 39.89 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General cigna Workers Comp O 33.38 1.89 27.86 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General geha EPO O 33.38 1.89 43.95 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General geha HMO O 33.38 1.89 43.95 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General geha Medicaid O 33.38 1.89 43.95 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General geha Medicare Part A O 33.38 1.89 43.95 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General geha Medicare Part B O 33.38 1.89 43.95 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General geha POS O 33.38 1.89 43.95 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General geha PPO O 33.38 1.89 43.95 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General geha Workers Comp O 33.38 1.89 43.95 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General healthchoice EPO O 33.38 1.89 2.59 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General healthchoice HMO O 33.38 1.89 2.59 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General healthchoice Medicaid O 33.38 1.89 2.59 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General healthchoice Medicare Part A O 33.38 1.89 2.59 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General healthchoice Medicare Part B O 33.38 1.89 2.59 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General healthchoice POS O 33.38 1.89 2.59 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General healthchoice PPO O 33.38 1.89 2.59 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General healthchoice Workers Comp O 33.38 1.89 2.59 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General humana - medicare advantage EPO I 70.37 18.60 68.44 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General humana - medicare advantage EPO O 33.38 1.89 42.64 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General humana - medicare advantage HMO I 70.37 18.60 68.44 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General humana - medicare advantage HMO O 33.38 1.89 42.64 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General humana - medicare advantage Medicaid I 70.37 18.60 68.44 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General humana - medicare advantage Medicaid O 33.38 1.89 42.64 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General humana - medicare advantage Medicare Part A I 70.37 18.60 68.44 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General humana - medicare advantage Medicare Part A O 33.38 1.89 42.64 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General humana - medicare advantage Medicare Part B I 70.37 18.60 68.44 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General humana - medicare advantage Medicare Part B O 33.38 1.89 42.64 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General humana - medicare advantage POS I 70.37 18.60 68.44 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General humana - medicare advantage POS O 33.38 1.89 42.64 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General humana - medicare advantage PPO I 70.37 18.60 68.44 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General humana - medicare advantage PPO O 33.38 1.89 42.64 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General humana - medicare advantage Workers Comp I 70.37 18.60 68.44 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General humana - medicare advantage Workers Comp O 33.38 1.89 42.64 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General medica EPO O 33.38 1.89 12.73 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General medica HMO O 33.38 1.89 12.73 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General medica Medicaid O 33.38 1.89 12.73 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General medica Medicare Part A O 33.38 1.89 12.73 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General medica Medicare Part B O 33.38 1.89 12.73 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General medica POS O 33.38 1.89 12.73 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General medica PPO O 33.38 1.89 12.73 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General medica Workers Comp O 33.38 1.89 12.73 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General tricare EPO O 33.38 1.89 94.96 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General tricare HMO O 33.38 1.89 94.96 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General tricare Medicaid O 33.38 1.89 94.96 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General tricare Medicare Part A O 33.38 1.89 94.96 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General tricare Medicare Part B O 33.38 1.89 94.96 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General tricare POS O 33.38 1.89 94.96 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General tricare PPO O 33.38 1.89 94.96 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General tricare Workers Comp O 33.38 1.89 94.96 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare EPO I 70.37 18.60 47.62 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare EPO O 33.38 1.89 21.25 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare HMO I 70.37 18.60 47.62 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare HMO O 33.38 1.89 21.25 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare Medicaid I 70.37 18.60 47.62 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare Medicaid O 33.38 1.89 21.25 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare Medicare Part A I 70.37 18.60 47.62 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare Medicare Part A O 33.38 1.89 21.25 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare Medicare Part B I 70.37 18.60 47.62 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare Medicare Part B O 33.38 1.89 21.25 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare POS I 70.37 18.60 47.62 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare POS O 33.38 1.89 21.25 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare PPO I 70.37 18.60 47.62 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare PPO O 33.38 1.89 21.25 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare Workers Comp I 70.37 18.60 47.62 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare Workers Comp O 33.38 1.89 21.25 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare - medicare advantage EPO O 33.38 1.89 1.89 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare - medicare advantage HMO O 33.38 1.89 1.89 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare - medicare advantage Medicaid O 33.38 1.89 1.89 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare - medicare advantage Medicare Part A O 33.38 1.89 1.89 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare - medicare advantage Medicare Part B O 33.38 1.89 1.89 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare - medicare advantage POS O 33.38 1.89 1.89 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare - medicare advantage PPO O 33.38 1.89 1.89 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General united healthcare - medicare advantage Workers Comp O 33.38 1.89 1.89 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General va EPO I 70.37 18.60 18.60 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General va EPO O 33.38 1.89 33.04 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General va HMO I 70.37 18.60 18.60 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General va HMO O 33.38 1.89 33.04 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General va Medicaid I 70.37 18.60 18.60 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General va Medicaid O 33.38 1.89 33.04 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General va Medicare Part A I 70.37 18.60 18.60 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General va Medicare Part A O 33.38 1.89 33.04 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General va Medicare Part B I 70.37 18.60 18.60 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General va Medicare Part B O 33.38 1.89 33.04 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General va POS I 70.37 18.60 18.60 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General va POS O 33.38 1.89 33.04 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General va PPO I 70.37 18.60 18.60 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General va PPO O 33.38 1.89 33.04 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General va Workers Comp I 70.37 18.60 18.60 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General va Workers Comp O 33.38 1.89 33.04 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General webtpa EPO O 33.38 1.89 16.34 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General webtpa HMO O 33.38 1.89 16.34 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General webtpa Medicaid O 33.38 1.89 16.34 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General webtpa Medicare Part A O 33.38 1.89 16.34 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General webtpa Medicare Part B O 33.38 1.89 16.34 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General webtpa POS O 33.38 1.89 16.34 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General webtpa PPO O 33.38 1.89 16.34 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General webtpa Workers Comp O 33.38 1.89 16.34 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General worker comp EPO I 70.37 18.60 148.88 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General worker comp EPO O 33.38 1.89 25.92 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General worker comp HMO I 70.37 18.60 148.88 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General worker comp HMO O 33.38 1.89 25.92 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General worker comp Medicaid I 70.37 18.60 148.88 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General worker comp Medicaid O 33.38 1.89 25.92 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General worker comp Medicare Part A I 70.37 18.60 148.88 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General worker comp Medicare Part A O 33.38 1.89 25.92 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General worker comp Medicare Part B I 70.37 18.60 148.88 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General worker comp Medicare Part B O 33.38 1.89 25.92 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General worker comp POS I 70.37 18.60 148.88 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General worker comp POS O 33.38 1.89 25.92 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General worker comp PPO I 70.37 18.60 148.88 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General worker comp PPO O 33.38 1.89 25.92 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General worker comp Workers Comp I 70.37 18.60 148.88 148.88 42.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0270 null revCode Medical/Surgical Supplies and Devices General worker comp Workers Comp O 33.38 1.89 25.92 94.96 20.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile aetna EPO O 89.04 13.18 36.27 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile aetna HMO O 89.04 13.18 36.27 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile aetna Medicaid O 89.04 13.18 36.27 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile aetna Medicare Part A O 89.04 13.18 36.27 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile aetna Medicare Part B O 89.04 13.18 36.27 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile aetna POS O 89.04 13.18 36.27 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile aetna PPO O 89.04 13.18 36.27 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile aetna Workers Comp O 89.04 13.18 36.27 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile blue cross blue shield EPO O 89.04 13.18 101.68 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile blue cross blue shield HMO O 89.04 13.18 101.68 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile blue cross blue shield Medicaid O 89.04 13.18 101.68 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile blue cross blue shield Medicare Part A O 89.04 13.18 101.68 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile blue cross blue shield Medicare Part B O 89.04 13.18 101.68 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile blue cross blue shield POS O 89.04 13.18 101.68 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile blue cross blue shield PPO O 89.04 13.18 101.68 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile blue cross blue shield Workers Comp O 89.04 13.18 101.68 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile blue cross blue shield - medicare advantage EPO O 89.04 13.18 13.18 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile blue cross blue shield - medicare advantage HMO O 89.04 13.18 13.18 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile blue cross blue shield - medicare advantage Medicaid O 89.04 13.18 13.18 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile blue cross blue shield - medicare advantage Medicare Part A O 89.04 13.18 13.18 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile blue cross blue shield - medicare advantage Medicare Part B O 89.04 13.18 13.18 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile blue cross blue shield - medicare advantage POS O 89.04 13.18 13.18 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile blue cross blue shield - medicare advantage PPO O 89.04 13.18 13.18 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile blue cross blue shield - medicare advantage Workers Comp O 89.04 13.18 13.18 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile cigna EPO I 618.82 53.36 629.11 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile cigna EPO O 89.04 13.18 256.75 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile cigna HMO I 618.82 53.36 629.11 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile cigna HMO O 89.04 13.18 256.75 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile cigna Medicaid I 618.82 53.36 629.11 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile cigna Medicaid O 89.04 13.18 256.75 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile cigna Medicare Part A I 618.82 53.36 629.11 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile cigna Medicare Part A O 89.04 13.18 256.75 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile cigna Medicare Part B I 618.82 53.36 629.11 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile cigna Medicare Part B O 89.04 13.18 256.75 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile cigna POS I 618.82 53.36 629.11 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile cigna POS O 89.04 13.18 256.75 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile cigna PPO I 618.82 53.36 629.11 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile cigna PPO O 89.04 13.18 256.75 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile cigna Workers Comp I 618.82 53.36 629.11 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile cigna Workers Comp O 89.04 13.18 256.75 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile humana - medicare advantage EPO I 618.82 53.36 345.56 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile humana - medicare advantage HMO I 618.82 53.36 345.56 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile humana - medicare advantage Medicaid I 618.82 53.36 345.56 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile humana - medicare advantage Medicare Part A I 618.82 53.36 345.56 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile humana - medicare advantage Medicare Part B I 618.82 53.36 345.56 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile humana - medicare advantage POS I 618.82 53.36 345.56 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile humana - medicare advantage PPO I 618.82 53.36 345.56 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile humana - medicare advantage Workers Comp I 618.82 53.36 345.56 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile united healthcare EPO O 89.04 13.18 259.17 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile united healthcare HMO O 89.04 13.18 259.17 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile united healthcare Medicaid O 89.04 13.18 259.17 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile united healthcare Medicare Part A O 89.04 13.18 259.17 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile united healthcare Medicare Part B O 89.04 13.18 259.17 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile united healthcare POS O 89.04 13.18 259.17 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile united healthcare PPO O 89.04 13.18 259.17 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile united healthcare Workers Comp O 89.04 13.18 259.17 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile va EPO I 618.82 53.36 53.36 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile va EPO O 89.04 13.18 345.56 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile va HMO I 618.82 53.36 53.36 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile va HMO O 89.04 13.18 345.56 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile va Medicaid I 618.82 53.36 53.36 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile va Medicaid O 89.04 13.18 345.56 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile va Medicare Part A I 618.82 53.36 53.36 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile va Medicare Part A O 89.04 13.18 345.56 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile va Medicare Part B I 618.82 53.36 53.36 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile va Medicare Part B O 89.04 13.18 345.56 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile va POS I 618.82 53.36 53.36 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile va POS O 89.04 13.18 345.56 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile va PPO I 618.82 53.36 53.36 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile va PPO O 89.04 13.18 345.56 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile va Workers Comp I 618.82 53.36 53.36 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile va Workers Comp O 89.04 13.18 345.56 345.56 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile worker comp EPO I 618.82 53.36 7151.82 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile worker comp HMO I 618.82 53.36 7151.82 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile worker comp Medicaid I 618.82 53.36 7151.82 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile worker comp Medicare Part A I 618.82 53.36 7151.82 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile worker comp Medicare Part B I 618.82 53.36 7151.82 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile worker comp POS I 618.82 53.36 7151.82 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile worker comp PPO I 618.82 53.36 7151.82 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0272 null revCode Medical/Surgical Supplies and Devices Sterile worker comp Workers Comp I 618.82 53.36 7151.82 7151.82 371.29 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices blue cross blue shield EPO O 89.04 7.44 7.44 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices blue cross blue shield HMO O 89.04 7.44 7.44 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices blue cross blue shield Medicaid O 89.04 7.44 7.44 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices blue cross blue shield Medicare Part A O 89.04 7.44 7.44 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices blue cross blue shield Medicare Part B O 89.04 7.44 7.44 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices blue cross blue shield POS O 89.04 7.44 7.44 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices blue cross blue shield PPO O 89.04 7.44 7.44 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices blue cross blue shield Workers Comp O 89.04 7.44 7.44 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices blue cross blue shield - medicare advantage EPO O 89.04 7.44 19.98 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices blue cross blue shield - medicare advantage HMO O 89.04 7.44 19.98 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices blue cross blue shield - medicare advantage Medicaid O 89.04 7.44 19.98 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices blue cross blue shield - medicare advantage Medicare Part A O 89.04 7.44 19.98 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices blue cross blue shield - medicare advantage Medicare Part B O 89.04 7.44 19.98 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices blue cross blue shield - medicare advantage POS O 89.04 7.44 19.98 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices blue cross blue shield - medicare advantage PPO O 89.04 7.44 19.98 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices blue cross blue shield - medicare advantage Workers Comp O 89.04 7.44 19.98 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices geha EPO O 89.04 7.44 586.71 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices geha HMO O 89.04 7.44 586.71 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices geha Medicaid O 89.04 7.44 586.71 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices geha Medicare Part A O 89.04 7.44 586.71 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices geha Medicare Part B O 89.04 7.44 586.71 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices geha POS O 89.04 7.44 586.71 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices geha PPO O 89.04 7.44 586.71 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices geha Workers Comp O 89.04 7.44 586.71 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices humana - medicare advantage EPO I 350.59 61.24 89.04 89.04 210.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices humana - medicare advantage EPO O 89.04 7.44 156.49 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices humana - medicare advantage HMO I 350.59 61.24 89.04 89.04 210.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices humana - medicare advantage HMO O 89.04 7.44 156.49 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices humana - medicare advantage Medicaid I 350.59 61.24 89.04 89.04 210.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices humana - medicare advantage Medicaid O 89.04 7.44 156.49 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices humana - medicare advantage Medicare Part A I 350.59 61.24 89.04 89.04 210.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices humana - medicare advantage Medicare Part A O 89.04 7.44 156.49 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices humana - medicare advantage Medicare Part B I 350.59 61.24 89.04 89.04 210.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices humana - medicare advantage Medicare Part B O 89.04 7.44 156.49 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices humana - medicare advantage POS I 350.59 61.24 89.04 89.04 210.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices humana - medicare advantage POS O 89.04 7.44 156.49 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices humana - medicare advantage PPO I 350.59 61.24 89.04 89.04 210.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices humana - medicare advantage PPO O 89.04 7.44 156.49 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices humana - medicare advantage Workers Comp I 350.59 61.24 89.04 89.04 210.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices humana - medicare advantage Workers Comp O 89.04 7.44 156.49 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices tricare EPO O 89.04 7.44 94.38 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices tricare HMO O 89.04 7.44 94.38 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices tricare Medicaid O 89.04 7.44 94.38 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices tricare Medicare Part A O 89.04 7.44 94.38 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices tricare Medicare Part B O 89.04 7.44 94.38 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices tricare POS O 89.04 7.44 94.38 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices tricare PPO O 89.04 7.44 94.38 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices tricare Workers Comp O 89.04 7.44 94.38 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices united healthcare EPO O 89.04 7.44 14.39 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices united healthcare HMO O 89.04 7.44 14.39 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices united healthcare Medicaid O 89.04 7.44 14.39 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices united healthcare Medicare Part A O 89.04 7.44 14.39 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices united healthcare Medicare Part B O 89.04 7.44 14.39 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices united healthcare POS O 89.04 7.44 14.39 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices united healthcare PPO O 89.04 7.44 14.39 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices united healthcare Workers Comp O 89.04 7.44 14.39 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices va EPO I 350.59 61.24 61.24 89.04 210.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices va EPO O 89.04 7.44 8.94 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices va HMO I 350.59 61.24 61.24 89.04 210.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices va HMO O 89.04 7.44 8.94 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices va Medicaid I 350.59 61.24 61.24 89.04 210.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices va Medicaid O 89.04 7.44 8.94 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices va Medicare Part A I 350.59 61.24 61.24 89.04 210.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices va Medicare Part A O 89.04 7.44 8.94 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices va Medicare Part B I 350.59 61.24 61.24 89.04 210.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices va Medicare Part B O 89.04 7.44 8.94 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices va POS I 350.59 61.24 61.24 89.04 210.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices va POS O 89.04 7.44 8.94 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices va PPO I 350.59 61.24 61.24 89.04 210.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices va PPO O 89.04 7.44 8.94 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices va Workers Comp I 350.59 61.24 61.24 89.04 210.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0274 null revCode Medical/Surgical Supplies and Devices Prosthetic/orthotic devices va Workers Comp O 89.04 7.44 8.94 586.71 53.42 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0275 null revCode Medical/Surgical Supplies and Devices Pacemaker blue cross blue shield EPO O 2887.12 1372.53 1488.40 1488.40 1732.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0275 null revCode Medical/Surgical Supplies and Devices Pacemaker blue cross blue shield HMO O 2887.12 1372.53 1488.40 1488.40 1732.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0275 null revCode Medical/Surgical Supplies and Devices Pacemaker blue cross blue shield Medicaid O 2887.12 1372.53 1488.40 1488.40 1732.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0275 null revCode Medical/Surgical Supplies and Devices Pacemaker blue cross blue shield Medicare Part A O 2887.12 1372.53 1488.40 1488.40 1732.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0275 null revCode Medical/Surgical Supplies and Devices Pacemaker blue cross blue shield Medicare Part B O 2887.12 1372.53 1488.40 1488.40 1732.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0275 null revCode Medical/Surgical Supplies and Devices Pacemaker blue cross blue shield POS O 2887.12 1372.53 1488.40 1488.40 1732.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0275 null revCode Medical/Surgical Supplies and Devices Pacemaker blue cross blue shield PPO O 2887.12 1372.53 1488.40 1488.40 1732.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0275 null revCode Medical/Surgical Supplies and Devices Pacemaker blue cross blue shield Workers Comp O 2887.12 1372.53 1488.40 1488.40 1732.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0275 null revCode Medical/Surgical Supplies and Devices Pacemaker blue cross blue shield - medicare advantage EPO O 2887.12 1372.53 1372.53 1488.40 1732.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0275 null revCode Medical/Surgical Supplies and Devices Pacemaker blue cross blue shield - medicare advantage HMO O 2887.12 1372.53 1372.53 1488.40 1732.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0275 null revCode Medical/Surgical Supplies and Devices Pacemaker blue cross blue shield - medicare advantage Medicaid O 2887.12 1372.53 1372.53 1488.40 1732.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0275 null revCode Medical/Surgical Supplies and Devices Pacemaker blue cross blue shield - medicare advantage Medicare Part A O 2887.12 1372.53 1372.53 1488.40 1732.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0275 null revCode Medical/Surgical Supplies and Devices Pacemaker blue cross blue shield - medicare advantage Medicare Part B O 2887.12 1372.53 1372.53 1488.40 1732.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0275 null revCode Medical/Surgical Supplies and Devices Pacemaker blue cross blue shield - medicare advantage POS O 2887.12 1372.53 1372.53 1488.40 1732.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0275 null revCode Medical/Surgical Supplies and Devices Pacemaker blue cross blue shield - medicare advantage PPO O 2887.12 1372.53 1372.53 1488.40 1732.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0275 null revCode Medical/Surgical Supplies and Devices Pacemaker blue cross blue shield - medicare advantage Workers Comp O 2887.12 1372.53 1372.53 1488.40 1732.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens aetna EPO O 716.56 173.98 268.00 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens aetna HMO O 716.56 173.98 268.00 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens aetna Medicaid O 716.56 173.98 268.00 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens aetna Medicare Part A O 716.56 173.98 268.00 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens aetna Medicare Part B O 716.56 173.98 268.00 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens aetna POS O 716.56 173.98 268.00 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens aetna PPO O 716.56 173.98 268.00 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens aetna Workers Comp O 716.56 173.98 268.00 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens blue cross blue shield EPO O 716.56 173.98 184.38 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens blue cross blue shield HMO O 716.56 173.98 184.38 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens blue cross blue shield Medicaid O 716.56 173.98 184.38 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens blue cross blue shield Medicare Part A O 716.56 173.98 184.38 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens blue cross blue shield Medicare Part B O 716.56 173.98 184.38 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens blue cross blue shield POS O 716.56 173.98 184.38 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens blue cross blue shield PPO O 716.56 173.98 184.38 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens blue cross blue shield Workers Comp O 716.56 173.98 184.38 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens blue cross blue shield - medicare advantage EPO O 716.56 173.98 173.98 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens blue cross blue shield - medicare advantage HMO O 716.56 173.98 173.98 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens blue cross blue shield - medicare advantage Medicaid O 716.56 173.98 173.98 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens blue cross blue shield - medicare advantage Medicare Part A O 716.56 173.98 173.98 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens blue cross blue shield - medicare advantage Medicare Part B O 716.56 173.98 173.98 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens blue cross blue shield - medicare advantage POS O 716.56 173.98 173.98 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens blue cross blue shield - medicare advantage PPO O 716.56 173.98 173.98 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0276 null revCode Medical/Surgical Supplies and Devices Intracular lens blue cross blue shield - medicare advantage Workers Comp O 716.56 173.98 173.98 268.00 429.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants aetna EPO I 14323.19 563.65 1501.07 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants aetna EPO O 1029.12 187.28 10720.32 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants aetna HMO I 14323.19 563.65 1501.07 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants aetna HMO O 1029.12 187.28 10720.32 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants aetna Medicaid I 14323.19 563.65 1501.07 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants aetna Medicaid O 1029.12 187.28 10720.32 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants aetna Medicare Part A I 14323.19 563.65 1501.07 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants aetna Medicare Part A O 1029.12 187.28 10720.32 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants aetna Medicare Part B I 14323.19 563.65 1501.07 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants aetna Medicare Part B O 1029.12 187.28 10720.32 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants aetna POS I 14323.19 563.65 1501.07 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants aetna POS O 1029.12 187.28 10720.32 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants aetna PPO I 14323.19 563.65 1501.07 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants aetna PPO O 1029.12 187.28 10720.32 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants aetna Workers Comp I 14323.19 563.65 1501.07 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants aetna Workers Comp O 1029.12 187.28 10720.32 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants blue cross blue shield EPO O 1029.12 187.28 301.37 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants blue cross blue shield HMO O 1029.12 187.28 301.37 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants blue cross blue shield Medicaid O 1029.12 187.28 301.37 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants blue cross blue shield Medicare Part A O 1029.12 187.28 301.37 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants blue cross blue shield Medicare Part B O 1029.12 187.28 301.37 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants blue cross blue shield POS O 1029.12 187.28 301.37 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants blue cross blue shield PPO O 1029.12 187.28 301.37 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants blue cross blue shield Workers Comp O 1029.12 187.28 301.37 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants blue cross blue shield - medicare advantage EPO O 1029.12 187.28 187.28 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants blue cross blue shield - medicare advantage HMO O 1029.12 187.28 187.28 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants blue cross blue shield - medicare advantage Medicaid O 1029.12 187.28 187.28 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants blue cross blue shield - medicare advantage Medicare Part A O 1029.12 187.28 187.28 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants blue cross blue shield - medicare advantage Medicare Part B O 1029.12 187.28 187.28 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants blue cross blue shield - medicare advantage POS O 1029.12 187.28 187.28 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants blue cross blue shield - medicare advantage PPO O 1029.12 187.28 187.28 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants blue cross blue shield - medicare advantage Workers Comp O 1029.12 187.28 187.28 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants cigna EPO O 1029.12 187.28 3019.83 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants cigna HMO O 1029.12 187.28 3019.83 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants cigna Medicaid O 1029.12 187.28 3019.83 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants cigna Medicare Part A O 1029.12 187.28 3019.83 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants cigna Medicare Part B O 1029.12 187.28 3019.83 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants cigna POS O 1029.12 187.28 3019.83 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants cigna PPO O 1029.12 187.28 3019.83 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants cigna Workers Comp O 1029.12 187.28 3019.83 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants humana - medicare advantage EPO I 14323.19 563.65 4549.04 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants humana - medicare advantage HMO I 14323.19 563.65 4549.04 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants humana - medicare advantage Medicaid I 14323.19 563.65 4549.04 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants humana - medicare advantage Medicare Part A I 14323.19 563.65 4549.04 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants humana - medicare advantage Medicare Part B I 14323.19 563.65 4549.04 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants humana - medicare advantage POS I 14323.19 563.65 4549.04 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants humana - medicare advantage PPO I 14323.19 563.65 4549.04 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants humana - medicare advantage Workers Comp I 14323.19 563.65 4549.04 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants united healthcare EPO I 14323.19 563.65 563.65 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants united healthcare EPO O 1029.12 187.28 781.49 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants united healthcare HMO I 14323.19 563.65 563.65 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants united healthcare HMO O 1029.12 187.28 781.49 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants united healthcare Medicaid I 14323.19 563.65 563.65 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants united healthcare Medicaid O 1029.12 187.28 781.49 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants united healthcare Medicare Part A I 14323.19 563.65 563.65 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants united healthcare Medicare Part A O 1029.12 187.28 781.49 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants united healthcare Medicare Part B I 14323.19 563.65 563.65 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants united healthcare Medicare Part B O 1029.12 187.28 781.49 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants united healthcare POS I 14323.19 563.65 563.65 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants united healthcare POS O 1029.12 187.28 781.49 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants united healthcare PPO I 14323.19 563.65 563.65 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants united healthcare PPO O 1029.12 187.28 781.49 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants united healthcare Workers Comp I 14323.19 563.65 563.65 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants united healthcare Workers Comp O 1029.12 187.28 781.49 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants va EPO I 14323.19 563.65 2181.77 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants va EPO O 1029.12 187.28 794.15 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants va HMO I 14323.19 563.65 2181.77 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants va HMO O 1029.12 187.28 794.15 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants va Medicaid I 14323.19 563.65 2181.77 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants va Medicaid O 1029.12 187.28 794.15 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants va Medicare Part A I 14323.19 563.65 2181.77 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants va Medicare Part A O 1029.12 187.28 794.15 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants va Medicare Part B I 14323.19 563.65 2181.77 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants va Medicare Part B O 1029.12 187.28 794.15 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants va POS I 14323.19 563.65 2181.77 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants va POS O 1029.12 187.28 794.15 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants va PPO I 14323.19 563.65 2181.77 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants va PPO O 1029.12 187.28 794.15 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants va Workers Comp I 14323.19 563.65 2181.77 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants va Workers Comp O 1029.12 187.28 794.15 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants webtpa EPO O 1029.12 187.28 14535.84 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants webtpa HMO O 1029.12 187.28 14535.84 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants webtpa Medicaid O 1029.12 187.28 14535.84 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants webtpa Medicare Part A O 1029.12 187.28 14535.84 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants webtpa Medicare Part B O 1029.12 187.28 14535.84 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants webtpa POS O 1029.12 187.28 14535.84 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants webtpa PPO O 1029.12 187.28 14535.84 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants webtpa Workers Comp O 1029.12 187.28 14535.84 14535.84 617.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants worker comp EPO I 14323.19 563.65 652.33 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants worker comp HMO I 14323.19 563.65 652.33 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants worker comp Medicaid I 14323.19 563.65 652.33 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants worker comp Medicare Part A I 14323.19 563.65 652.33 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants worker comp Medicare Part B I 14323.19 563.65 652.33 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants worker comp POS I 14323.19 563.65 652.33 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants worker comp PPO I 14323.19 563.65 652.33 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0278 null revCode Medical/Surgical Supplies and Devices Other implants worker comp Workers Comp I 14323.19 563.65 652.33 4549.04 8593.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 028 null ms-drg spinal procedures with mcc united healthcare EPO I 109892.64 82419.49 82419.49 82419.49 65935.58 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 028 null ms-drg spinal procedures with mcc united healthcare HMO I 109892.64 82419.49 82419.49 82419.49 65935.58 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 028 null ms-drg spinal procedures with mcc united healthcare Medicaid I 109892.64 82419.49 82419.49 82419.49 65935.58 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 028 null ms-drg spinal procedures with mcc united healthcare Medicare Part A I 109892.64 82419.49 82419.49 82419.49 65935.58 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 028 null ms-drg spinal procedures with mcc united healthcare Medicare Part B I 109892.64 82419.49 82419.49 82419.49 65935.58 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 028 null ms-drg spinal procedures with mcc united healthcare POS I 109892.64 82419.49 82419.49 82419.49 65935.58 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 028 null ms-drg spinal procedures with mcc united healthcare PPO I 109892.64 82419.49 82419.49 82419.49 65935.58 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 028 null ms-drg spinal procedures with mcc united healthcare Workers Comp I 109892.64 82419.49 82419.49 82419.49 65935.58 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General aetna EPO O 181.41 23.80 101.94 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General aetna HMO O 181.41 23.80 101.94 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General aetna Medicaid O 181.41 23.80 101.94 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General aetna Medicare Part A O 181.41 23.80 101.94 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General aetna Medicare Part B O 181.41 23.80 101.94 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General aetna POS O 181.41 23.80 101.94 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General aetna PPO O 181.41 23.80 101.94 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General aetna Workers Comp O 181.41 23.80 101.94 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General aetna - medicare advantage EPO O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General aetna - medicare advantage HMO O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General aetna - medicare advantage Medicaid O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General aetna - medicare advantage Medicare Part A O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General aetna - medicare advantage Medicare Part B O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General aetna - medicare advantage POS O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General aetna - medicare advantage PPO O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General aetna - medicare advantage Workers Comp O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General blue cross blue shield EPO O 181.41 23.80 130.46 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General blue cross blue shield HMO O 181.41 23.80 130.46 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General blue cross blue shield Medicaid O 181.41 23.80 130.46 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General blue cross blue shield Medicare Part A O 181.41 23.80 130.46 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General blue cross blue shield Medicare Part B O 181.41 23.80 130.46 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General blue cross blue shield POS O 181.41 23.80 130.46 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General blue cross blue shield PPO O 181.41 23.80 130.46 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General blue cross blue shield Workers Comp O 181.41 23.80 130.46 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General blue cross blue shield - medicare advantage EPO O 181.41 23.80 23.80 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General blue cross blue shield - medicare advantage HMO O 181.41 23.80 23.80 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General blue cross blue shield - medicare advantage Medicaid O 181.41 23.80 23.80 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General blue cross blue shield - medicare advantage Medicare Part A O 181.41 23.80 23.80 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General blue cross blue shield - medicare advantage Medicare Part B O 181.41 23.80 23.80 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General blue cross blue shield - medicare advantage POS O 181.41 23.80 23.80 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General blue cross blue shield - medicare advantage PPO O 181.41 23.80 23.80 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General blue cross blue shield - medicare advantage Workers Comp O 181.41 23.80 23.80 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General cigna EPO O 181.41 23.80 121.12 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General cigna HMO O 181.41 23.80 121.12 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General cigna Medicaid O 181.41 23.80 121.12 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General cigna Medicare Part A O 181.41 23.80 121.12 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General cigna Medicare Part B O 181.41 23.80 121.12 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General cigna POS O 181.41 23.80 121.12 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General cigna PPO O 181.41 23.80 121.12 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General cigna Workers Comp O 181.41 23.80 121.12 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General humana - medicare advantage EPO O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General humana - medicare advantage HMO O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General humana - medicare advantage Medicaid O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General humana - medicare advantage Medicare Part A O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General humana - medicare advantage Medicare Part B O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General humana - medicare advantage POS O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General humana - medicare advantage PPO O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General humana - medicare advantage Workers Comp O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General tricare EPO O 181.41 23.80 48.73 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General tricare HMO O 181.41 23.80 48.73 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General tricare Medicaid O 181.41 23.80 48.73 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General tricare Medicare Part A O 181.41 23.80 48.73 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General tricare Medicare Part B O 181.41 23.80 48.73 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General tricare POS O 181.41 23.80 48.73 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General tricare PPO O 181.41 23.80 48.73 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General tricare Workers Comp O 181.41 23.80 48.73 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General united healthcare EPO O 181.41 23.80 129.59 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General united healthcare HMO O 181.41 23.80 129.59 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General united healthcare Medicaid O 181.41 23.80 129.59 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General united healthcare Medicare Part A O 181.41 23.80 129.59 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General united healthcare Medicare Part B O 181.41 23.80 129.59 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General united healthcare POS O 181.41 23.80 129.59 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General united healthcare PPO O 181.41 23.80 129.59 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General united healthcare Workers Comp O 181.41 23.80 129.59 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General united healthcare - medicare advantage EPO O 181.41 23.80 47.76 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General united healthcare - medicare advantage HMO O 181.41 23.80 47.76 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General united healthcare - medicare advantage Medicaid O 181.41 23.80 47.76 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General united healthcare - medicare advantage Medicare Part A O 181.41 23.80 47.76 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General united healthcare - medicare advantage Medicare Part B O 181.41 23.80 47.76 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General united healthcare - medicare advantage POS O 181.41 23.80 47.76 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General united healthcare - medicare advantage PPO O 181.41 23.80 47.76 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General united healthcare - medicare advantage Workers Comp O 181.41 23.80 47.76 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General va EPO O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General va HMO O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General va Medicaid O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General va Medicare Part A O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General va Medicare Part B O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General va POS O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General va PPO O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General va Workers Comp O 181.41 23.80 49.29 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General webtpa EPO O 181.41 23.80 122.43 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General webtpa HMO O 181.41 23.80 122.43 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General webtpa Medicaid O 181.41 23.80 122.43 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General webtpa Medicare Part A O 181.41 23.80 122.43 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General webtpa Medicare Part B O 181.41 23.80 122.43 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General webtpa POS O 181.41 23.80 122.43 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General webtpa PPO O 181.41 23.80 122.43 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0280 null revCode Oncology General webtpa Workers Comp O 181.41 23.80 122.43 130.46 108.85 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 029 null ms-drg spinal procedures with cc or spinal neurostimulators blue cross blue shield EPO I 49002.02 35301.61 35301.61 35301.61 29401.21 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 029 null ms-drg spinal procedures with cc or spinal neurostimulators blue cross blue shield HMO I 49002.02 35301.61 35301.61 35301.61 29401.21 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 029 null ms-drg spinal procedures with cc or spinal neurostimulators blue cross blue shield Medicaid I 49002.02 35301.61 35301.61 35301.61 29401.21 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 029 null ms-drg spinal procedures with cc or spinal neurostimulators blue cross blue shield Medicare Part A I 49002.02 35301.61 35301.61 35301.61 29401.21 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 029 null ms-drg spinal procedures with cc or spinal neurostimulators blue cross blue shield Medicare Part B I 49002.02 35301.61 35301.61 35301.61 29401.21 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 029 null ms-drg spinal procedures with cc or spinal neurostimulators blue cross blue shield POS I 49002.02 35301.61 35301.61 35301.61 29401.21 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 029 null ms-drg spinal procedures with cc or spinal neurostimulators blue cross blue shield PPO I 49002.02 35301.61 35301.61 35301.61 29401.21 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 029 null ms-drg spinal procedures with cc or spinal neurostimulators blue cross blue shield Workers Comp I 49002.02 35301.61 35301.61 35301.61 29401.21 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna EPO I 136.29 43.20 72.74 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna EPO O 79.81 8.84 21.89 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna HMO I 136.29 43.20 72.74 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna HMO O 79.81 8.84 21.89 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna Medicaid I 136.29 43.20 72.74 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna Medicaid O 79.81 8.84 21.89 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna Medicare Part A I 136.29 43.20 72.74 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna Medicare Part A O 79.81 8.84 21.89 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna Medicare Part B I 136.29 43.20 72.74 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna Medicare Part B O 79.81 8.84 21.89 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna POS I 136.29 43.20 72.74 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna POS O 79.81 8.84 21.89 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna PPO I 136.29 43.20 72.74 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna PPO O 79.81 8.84 21.89 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna Workers Comp I 136.29 43.20 72.74 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna Workers Comp O 79.81 8.84 21.89 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna - medicare advantage EPO O 79.81 8.84 9.71 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna - medicare advantage HMO O 79.81 8.84 9.71 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna - medicare advantage Medicaid O 79.81 8.84 9.71 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna - medicare advantage Medicare Part A O 79.81 8.84 9.71 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna - medicare advantage Medicare Part B O 79.81 8.84 9.71 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna - medicare advantage POS O 79.81 8.84 9.71 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna - medicare advantage PPO O 79.81 8.84 9.71 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General aetna - medicare advantage Workers Comp O 79.81 8.84 9.71 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General blue cross blue shield EPO O 79.81 8.84 15.47 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General blue cross blue shield HMO O 79.81 8.84 15.47 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General blue cross blue shield Medicaid O 79.81 8.84 15.47 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General blue cross blue shield Medicare Part A O 79.81 8.84 15.47 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General blue cross blue shield Medicare Part B O 79.81 8.84 15.47 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General blue cross blue shield POS O 79.81 8.84 15.47 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General blue cross blue shield PPO O 79.81 8.84 15.47 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General blue cross blue shield Workers Comp O 79.81 8.84 15.47 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General blue cross blue shield - medicare advantage EPO O 79.81 8.84 14.67 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General blue cross blue shield - medicare advantage HMO O 79.81 8.84 14.67 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General blue cross blue shield - medicare advantage Medicaid O 79.81 8.84 14.67 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General blue cross blue shield - medicare advantage Medicare Part A O 79.81 8.84 14.67 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General blue cross blue shield - medicare advantage Medicare Part B O 79.81 8.84 14.67 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General blue cross blue shield - medicare advantage POS O 79.81 8.84 14.67 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General blue cross blue shield - medicare advantage PPO O 79.81 8.84 14.67 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General blue cross blue shield - medicare advantage Workers Comp O 79.81 8.84 14.67 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General cigna EPO I 136.29 43.20 122.77 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General cigna EPO O 79.81 8.84 55.95 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General cigna HMO I 136.29 43.20 122.77 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General cigna HMO O 79.81 8.84 55.95 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General cigna Medicaid I 136.29 43.20 122.77 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General cigna Medicaid O 79.81 8.84 55.95 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General cigna Medicare Part A I 136.29 43.20 122.77 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General cigna Medicare Part A O 79.81 8.84 55.95 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General cigna Medicare Part B I 136.29 43.20 122.77 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General cigna Medicare Part B O 79.81 8.84 55.95 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General cigna POS I 136.29 43.20 122.77 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General cigna POS O 79.81 8.84 55.95 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General cigna PPO I 136.29 43.20 122.77 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General cigna PPO O 79.81 8.84 55.95 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General cigna Workers Comp I 136.29 43.20 122.77 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General cigna Workers Comp O 79.81 8.84 55.95 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General geha EPO O 79.81 8.84 59.86 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General geha HMO O 79.81 8.84 59.86 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General geha Medicaid O 79.81 8.84 59.86 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General geha Medicare Part A O 79.81 8.84 59.86 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General geha Medicare Part B O 79.81 8.84 59.86 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General geha POS O 79.81 8.84 59.86 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General geha PPO O 79.81 8.84 59.86 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General geha Workers Comp O 79.81 8.84 59.86 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General healthchoice EPO O 79.81 8.84 22.80 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General healthchoice HMO O 79.81 8.84 22.80 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General healthchoice Medicaid O 79.81 8.84 22.80 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General healthchoice Medicare Part A O 79.81 8.84 22.80 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General healthchoice Medicare Part B O 79.81 8.84 22.80 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General healthchoice POS O 79.81 8.84 22.80 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General healthchoice PPO O 79.81 8.84 22.80 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General healthchoice Workers Comp O 79.81 8.84 22.80 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana EPO O 79.81 8.84 61.53 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana HMO O 79.81 8.84 61.53 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana Medicaid O 79.81 8.84 61.53 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana Medicare Part A O 79.81 8.84 61.53 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana Medicare Part B O 79.81 8.84 61.53 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana POS O 79.81 8.84 61.53 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana PPO O 79.81 8.84 61.53 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana Workers Comp O 79.81 8.84 61.53 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana - medicare advantage EPO I 136.29 43.20 111.13 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana - medicare advantage EPO O 79.81 8.84 9.44 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana - medicare advantage HMO I 136.29 43.20 111.13 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana - medicare advantage HMO O 79.81 8.84 9.44 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana - medicare advantage Medicaid I 136.29 43.20 111.13 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana - medicare advantage Medicaid O 79.81 8.84 9.44 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana - medicare advantage Medicare Part A I 136.29 43.20 111.13 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana - medicare advantage Medicare Part A O 79.81 8.84 9.44 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana - medicare advantage Medicare Part B I 136.29 43.20 111.13 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana - medicare advantage Medicare Part B O 79.81 8.84 9.44 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana - medicare advantage POS I 136.29 43.20 111.13 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana - medicare advantage POS O 79.81 8.84 9.44 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana - medicare advantage PPO I 136.29 43.20 111.13 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana - medicare advantage PPO O 79.81 8.84 9.44 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana - medicare advantage Workers Comp I 136.29 43.20 111.13 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General humana - medicare advantage Workers Comp O 79.81 8.84 9.44 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General medica EPO O 79.81 8.84 14.00 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General medica HMO O 79.81 8.84 14.00 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General medica Medicaid O 79.81 8.84 14.00 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General medica Medicare Part A O 79.81 8.84 14.00 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General medica Medicare Part B O 79.81 8.84 14.00 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General medica POS O 79.81 8.84 14.00 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General medica PPO O 79.81 8.84 14.00 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General medica Workers Comp O 79.81 8.84 14.00 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General tricare EPO O 79.81 8.84 10.37 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General tricare HMO O 79.81 8.84 10.37 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General tricare Medicaid O 79.81 8.84 10.37 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General tricare Medicare Part A O 79.81 8.84 10.37 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General tricare Medicare Part B O 79.81 8.84 10.37 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General tricare POS O 79.81 8.84 10.37 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General tricare PPO O 79.81 8.84 10.37 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General tricare Workers Comp O 79.81 8.84 10.37 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare EPO I 136.29 43.20 108.18 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare EPO O 79.81 8.84 54.26 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare HMO I 136.29 43.20 108.18 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare HMO O 79.81 8.84 54.26 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare Medicaid I 136.29 43.20 108.18 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare Medicaid O 79.81 8.84 54.26 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare Medicare Part A I 136.29 43.20 108.18 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare Medicare Part A O 79.81 8.84 54.26 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare Medicare Part B I 136.29 43.20 108.18 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare Medicare Part B O 79.81 8.84 54.26 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare POS I 136.29 43.20 108.18 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare POS O 79.81 8.84 54.26 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare PPO I 136.29 43.20 108.18 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare PPO O 79.81 8.84 54.26 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare Workers Comp I 136.29 43.20 108.18 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare Workers Comp O 79.81 8.84 54.26 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare - medicare advantage EPO O 79.81 8.84 8.84 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare - medicare advantage HMO O 79.81 8.84 8.84 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare - medicare advantage Medicaid O 79.81 8.84 8.84 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare - medicare advantage Medicare Part A O 79.81 8.84 8.84 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare - medicare advantage Medicare Part B O 79.81 8.84 8.84 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare - medicare advantage POS O 79.81 8.84 8.84 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare - medicare advantage PPO O 79.81 8.84 8.84 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General united healthcare - medicare advantage Workers Comp O 79.81 8.84 8.84 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General va EPO I 136.29 43.20 43.20 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General va EPO O 79.81 8.84 8.96 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General va HMO I 136.29 43.20 43.20 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General va HMO O 79.81 8.84 8.96 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General va Medicaid I 136.29 43.20 43.20 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General va Medicaid O 79.81 8.84 8.96 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General va Medicare Part A I 136.29 43.20 43.20 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General va Medicare Part A O 79.81 8.84 8.96 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General va Medicare Part B I 136.29 43.20 43.20 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General va Medicare Part B O 79.81 8.84 8.96 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General va POS I 136.29 43.20 43.20 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General va POS O 79.81 8.84 8.96 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General va PPO I 136.29 43.20 43.20 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General va PPO O 79.81 8.84 8.96 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General va Workers Comp I 136.29 43.20 43.20 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General va Workers Comp O 79.81 8.84 8.96 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General webtpa EPO O 79.81 8.84 115.19 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General webtpa HMO O 79.81 8.84 115.19 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General webtpa Medicaid O 79.81 8.84 115.19 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General webtpa Medicare Part A O 79.81 8.84 115.19 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General webtpa Medicare Part B O 79.81 8.84 115.19 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General webtpa POS O 79.81 8.84 115.19 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General webtpa PPO O 79.81 8.84 115.19 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General webtpa Workers Comp O 79.81 8.84 115.19 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General worker comp EPO I 136.29 43.20 89.32 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General worker comp EPO O 79.81 8.84 45.68 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General worker comp HMO I 136.29 43.20 89.32 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General worker comp HMO O 79.81 8.84 45.68 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General worker comp Medicaid I 136.29 43.20 89.32 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General worker comp Medicaid O 79.81 8.84 45.68 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General worker comp Medicare Part A I 136.29 43.20 89.32 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General worker comp Medicare Part A O 79.81 8.84 45.68 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General worker comp Medicare Part B I 136.29 43.20 89.32 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General worker comp Medicare Part B O 79.81 8.84 45.68 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General worker comp POS I 136.29 43.20 89.32 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General worker comp POS O 79.81 8.84 45.68 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General worker comp PPO I 136.29 43.20 89.32 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General worker comp PPO O 79.81 8.84 45.68 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General worker comp Workers Comp I 136.29 43.20 89.32 122.77 81.77 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0300 null revCode Laboratory General worker comp Workers Comp O 79.81 8.84 45.68 115.19 47.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna EPO I 169.17 43.81 98.12 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna EPO O 28.38 2.92 57.64 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna HMO I 169.17 43.81 98.12 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna HMO O 28.38 2.92 57.64 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna Medicaid I 169.17 43.81 98.12 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna Medicaid O 28.38 2.92 57.64 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna Medicare Part A I 169.17 43.81 98.12 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna Medicare Part A O 28.38 2.92 57.64 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna Medicare Part B I 169.17 43.81 98.12 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna Medicare Part B O 28.38 2.92 57.64 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna POS I 169.17 43.81 98.12 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna POS O 28.38 2.92 57.64 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna PPO I 169.17 43.81 98.12 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna PPO O 28.38 2.92 57.64 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna Workers Comp I 169.17 43.81 98.12 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna Workers Comp O 28.38 2.92 57.64 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna - medicare advantage EPO O 28.38 2.92 96.59 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna - medicare advantage HMO O 28.38 2.92 96.59 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna - medicare advantage Medicaid O 28.38 2.92 96.59 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna - medicare advantage Medicare Part A O 28.38 2.92 96.59 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna - medicare advantage Medicare Part B O 28.38 2.92 96.59 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna - medicare advantage POS O 28.38 2.92 96.59 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna - medicare advantage PPO O 28.38 2.92 96.59 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry aetna - medicare advantage Workers Comp O 28.38 2.92 96.59 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry blue cross blue shield EPO O 28.38 2.92 19.87 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry blue cross blue shield HMO O 28.38 2.92 19.87 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry blue cross blue shield Medicaid O 28.38 2.92 19.87 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry blue cross blue shield Medicare Part A O 28.38 2.92 19.87 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry blue cross blue shield Medicare Part B O 28.38 2.92 19.87 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry blue cross blue shield POS O 28.38 2.92 19.87 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry blue cross blue shield PPO O 28.38 2.92 19.87 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry blue cross blue shield Workers Comp O 28.38 2.92 19.87 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry blue cross blue shield - medicare advantage EPO O 28.38 2.92 7.37 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry blue cross blue shield - medicare advantage HMO O 28.38 2.92 7.37 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry blue cross blue shield - medicare advantage Medicaid O 28.38 2.92 7.37 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry blue cross blue shield - medicare advantage Medicare Part A O 28.38 2.92 7.37 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry blue cross blue shield - medicare advantage Medicare Part B O 28.38 2.92 7.37 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry blue cross blue shield - medicare advantage POS O 28.38 2.92 7.37 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry blue cross blue shield - medicare advantage PPO O 28.38 2.92 7.37 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry blue cross blue shield - medicare advantage Workers Comp O 28.38 2.92 7.37 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry cigna EPO I 169.17 43.81 119.71 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry cigna HMO I 169.17 43.81 119.71 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry cigna Medicaid I 169.17 43.81 119.71 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry cigna Medicare Part A I 169.17 43.81 119.71 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry cigna Medicare Part B I 169.17 43.81 119.71 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry cigna POS I 169.17 43.81 119.71 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry cigna PPO I 169.17 43.81 119.71 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry cigna Workers Comp I 169.17 43.81 119.71 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry humana - medicare advantage EPO I 169.17 43.81 169.17 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry humana - medicare advantage EPO O 28.38 2.92 3.64 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry humana - medicare advantage HMO I 169.17 43.81 169.17 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry humana - medicare advantage HMO O 28.38 2.92 3.64 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry humana - medicare advantage Medicaid I 169.17 43.81 169.17 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry humana - medicare advantage Medicaid O 28.38 2.92 3.64 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry humana - medicare advantage Medicare Part A I 169.17 43.81 169.17 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry humana - medicare advantage Medicare Part A O 28.38 2.92 3.64 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry humana - medicare advantage Medicare Part B I 169.17 43.81 169.17 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry humana - medicare advantage Medicare Part B O 28.38 2.92 3.64 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry humana - medicare advantage POS I 169.17 43.81 169.17 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry humana - medicare advantage POS O 28.38 2.92 3.64 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry humana - medicare advantage PPO I 169.17 43.81 169.17 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry humana - medicare advantage PPO O 28.38 2.92 3.64 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry humana - medicare advantage Workers Comp I 169.17 43.81 169.17 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry humana - medicare advantage Workers Comp O 28.38 2.92 3.64 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry tricare EPO O 28.38 2.92 3.65 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry tricare HMO O 28.38 2.92 3.65 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry tricare Medicaid O 28.38 2.92 3.65 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry tricare Medicare Part A O 28.38 2.92 3.65 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry tricare Medicare Part B O 28.38 2.92 3.65 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry tricare POS O 28.38 2.92 3.65 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry tricare PPO O 28.38 2.92 3.65 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry tricare Workers Comp O 28.38 2.92 3.65 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry united healthcare EPO O 28.38 2.92 70.56 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry united healthcare HMO O 28.38 2.92 70.56 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry united healthcare Medicaid O 28.38 2.92 70.56 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry united healthcare Medicare Part A O 28.38 2.92 70.56 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry united healthcare Medicare Part B O 28.38 2.92 70.56 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry united healthcare POS O 28.38 2.92 70.56 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry united healthcare PPO O 28.38 2.92 70.56 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry united healthcare Workers Comp O 28.38 2.92 70.56 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry va EPO I 169.17 43.81 43.81 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry va EPO O 28.38 2.92 2.92 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry va HMO I 169.17 43.81 43.81 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry va HMO O 28.38 2.92 2.92 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry va Medicaid I 169.17 43.81 43.81 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry va Medicaid O 28.38 2.92 2.92 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry va Medicare Part A I 169.17 43.81 43.81 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry va Medicare Part A O 28.38 2.92 2.92 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry va Medicare Part B I 169.17 43.81 43.81 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry va Medicare Part B O 28.38 2.92 2.92 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry va POS I 169.17 43.81 43.81 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry va POS O 28.38 2.92 2.92 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry va PPO I 169.17 43.81 43.81 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry va PPO O 28.38 2.92 2.92 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry va Workers Comp I 169.17 43.81 43.81 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry va Workers Comp O 28.38 2.92 2.92 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry webtpa EPO O 28.38 2.92 171.92 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry webtpa HMO O 28.38 2.92 171.92 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry webtpa Medicaid O 28.38 2.92 171.92 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry webtpa Medicare Part A O 28.38 2.92 171.92 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry webtpa Medicare Part B O 28.38 2.92 171.92 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry webtpa POS O 28.38 2.92 171.92 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry webtpa PPO O 28.38 2.92 171.92 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry webtpa Workers Comp O 28.38 2.92 171.92 171.92 17.03 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry worker comp EPO I 169.17 43.81 161.12 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry worker comp HMO I 169.17 43.81 161.12 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry worker comp Medicaid I 169.17 43.81 161.12 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry worker comp Medicare Part A I 169.17 43.81 161.12 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry worker comp Medicare Part B I 169.17 43.81 161.12 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry worker comp POS I 169.17 43.81 161.12 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry worker comp PPO I 169.17 43.81 161.12 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0301 null revCode Laboratory Chemistry worker comp Workers Comp I 169.17 43.81 161.12 169.17 101.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General aetna EPO I 219.60 42.76 158.23 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General aetna EPO O 238.18 32.09 138.14 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General aetna HMO I 219.60 42.76 158.23 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General aetna HMO O 238.18 32.09 138.14 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General aetna Medicaid I 219.60 42.76 158.23 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General aetna Medicaid O 238.18 32.09 138.14 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General aetna Medicare Part A I 219.60 42.76 158.23 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General aetna Medicare Part A O 238.18 32.09 138.14 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General aetna Medicare Part B I 219.60 42.76 158.23 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General aetna Medicare Part B O 238.18 32.09 138.14 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General aetna POS I 219.60 42.76 158.23 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General aetna POS O 238.18 32.09 138.14 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General aetna PPO I 219.60 42.76 158.23 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General aetna PPO O 238.18 32.09 138.14 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General aetna Workers Comp I 219.60 42.76 158.23 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General aetna Workers Comp O 238.18 32.09 138.14 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General blue cross blue shield EPO O 238.18 32.09 90.19 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General blue cross blue shield HMO O 238.18 32.09 90.19 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General blue cross blue shield Medicaid O 238.18 32.09 90.19 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General blue cross blue shield Medicare Part A O 238.18 32.09 90.19 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General blue cross blue shield Medicare Part B O 238.18 32.09 90.19 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General blue cross blue shield POS O 238.18 32.09 90.19 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General blue cross blue shield PPO O 238.18 32.09 90.19 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General blue cross blue shield Workers Comp O 238.18 32.09 90.19 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General blue cross blue shield - medicare advantage EPO O 238.18 32.09 79.12 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General blue cross blue shield - medicare advantage HMO O 238.18 32.09 79.12 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General blue cross blue shield - medicare advantage Medicaid O 238.18 32.09 79.12 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General blue cross blue shield - medicare advantage Medicare Part A O 238.18 32.09 79.12 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General blue cross blue shield - medicare advantage Medicare Part B O 238.18 32.09 79.12 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General blue cross blue shield - medicare advantage POS O 238.18 32.09 79.12 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General blue cross blue shield - medicare advantage PPO O 238.18 32.09 79.12 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General blue cross blue shield - medicare advantage Workers Comp O 238.18 32.09 79.12 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General cigna EPO I 219.60 42.76 170.51 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General cigna EPO O 238.18 32.09 159.02 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General cigna HMO I 219.60 42.76 170.51 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General cigna HMO O 238.18 32.09 159.02 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General cigna Medicaid I 219.60 42.76 170.51 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General cigna Medicaid O 238.18 32.09 159.02 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General cigna Medicare Part A I 219.60 42.76 170.51 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General cigna Medicare Part A O 238.18 32.09 159.02 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General cigna Medicare Part B I 219.60 42.76 170.51 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General cigna Medicare Part B O 238.18 32.09 159.02 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General cigna POS I 219.60 42.76 170.51 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General cigna POS O 238.18 32.09 159.02 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General cigna PPO I 219.60 42.76 170.51 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General cigna PPO O 238.18 32.09 159.02 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General cigna Workers Comp I 219.60 42.76 170.51 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General cigna Workers Comp O 238.18 32.09 159.02 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General geha EPO O 238.18 32.09 185.63 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General geha HMO O 238.18 32.09 185.63 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General geha Medicaid O 238.18 32.09 185.63 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General geha Medicare Part A O 238.18 32.09 185.63 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General geha Medicare Part B O 238.18 32.09 185.63 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General geha POS O 238.18 32.09 185.63 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General geha PPO O 238.18 32.09 185.63 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General geha Workers Comp O 238.18 32.09 185.63 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General healthchoice EPO O 238.18 32.09 32.09 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General healthchoice HMO O 238.18 32.09 32.09 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General healthchoice Medicaid O 238.18 32.09 32.09 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General healthchoice Medicare Part A O 238.18 32.09 32.09 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General healthchoice Medicare Part B O 238.18 32.09 32.09 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General healthchoice POS O 238.18 32.09 32.09 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General healthchoice PPO O 238.18 32.09 32.09 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General healthchoice Workers Comp O 238.18 32.09 32.09 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General humana - medicare advantage EPO I 219.60 42.76 179.71 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General humana - medicare advantage EPO O 238.18 32.09 43.82 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General humana - medicare advantage HMO I 219.60 42.76 179.71 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General humana - medicare advantage HMO O 238.18 32.09 43.82 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General humana - medicare advantage Medicaid I 219.60 42.76 179.71 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General humana - medicare advantage Medicaid O 238.18 32.09 43.82 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General humana - medicare advantage Medicare Part A I 219.60 42.76 179.71 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General humana - medicare advantage Medicare Part A O 238.18 32.09 43.82 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General humana - medicare advantage Medicare Part B I 219.60 42.76 179.71 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General humana - medicare advantage Medicare Part B O 238.18 32.09 43.82 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General humana - medicare advantage POS I 219.60 42.76 179.71 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General humana - medicare advantage POS O 238.18 32.09 43.82 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General humana - medicare advantage PPO I 219.60 42.76 179.71 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General humana - medicare advantage PPO O 238.18 32.09 43.82 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General humana - medicare advantage Workers Comp I 219.60 42.76 179.71 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General humana - medicare advantage Workers Comp O 238.18 32.09 43.82 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General medica EPO O 238.18 32.09 88.13 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General medica HMO O 238.18 32.09 88.13 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General medica Medicaid O 238.18 32.09 88.13 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General medica Medicare Part A O 238.18 32.09 88.13 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General medica Medicare Part B O 238.18 32.09 88.13 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General medica POS O 238.18 32.09 88.13 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General medica PPO O 238.18 32.09 88.13 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General medica Workers Comp O 238.18 32.09 88.13 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General tricare EPO O 238.18 32.09 43.82 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General tricare HMO O 238.18 32.09 43.82 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General tricare Medicaid O 238.18 32.09 43.82 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General tricare Medicare Part A O 238.18 32.09 43.82 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General tricare Medicare Part B O 238.18 32.09 43.82 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General tricare POS O 238.18 32.09 43.82 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General tricare PPO O 238.18 32.09 43.82 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General tricare Workers Comp O 238.18 32.09 43.82 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General united healthcare EPO O 238.18 32.09 170.13 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General united healthcare HMO O 238.18 32.09 170.13 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General united healthcare Medicaid O 238.18 32.09 170.13 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General united healthcare Medicare Part A O 238.18 32.09 170.13 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General united healthcare Medicare Part B O 238.18 32.09 170.13 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General united healthcare POS O 238.18 32.09 170.13 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General united healthcare PPO O 238.18 32.09 170.13 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General united healthcare Workers Comp O 238.18 32.09 170.13 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General va EPO I 219.60 42.76 42.76 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General va EPO O 238.18 32.09 200.34 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General va HMO I 219.60 42.76 42.76 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General va HMO O 238.18 32.09 200.34 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General va Medicaid I 219.60 42.76 42.76 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General va Medicaid O 238.18 32.09 200.34 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General va Medicare Part A I 219.60 42.76 42.76 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General va Medicare Part A O 238.18 32.09 200.34 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General va Medicare Part B I 219.60 42.76 42.76 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General va Medicare Part B O 238.18 32.09 200.34 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General va POS I 219.60 42.76 42.76 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General va POS O 238.18 32.09 200.34 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General va PPO I 219.60 42.76 42.76 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General va PPO O 238.18 32.09 200.34 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General va Workers Comp I 219.60 42.76 42.76 179.71 131.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General va Workers Comp O 238.18 32.09 200.34 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General webtpa EPO O 238.18 32.09 158.79 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General webtpa HMO O 238.18 32.09 158.79 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General webtpa Medicaid O 238.18 32.09 158.79 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General webtpa Medicare Part A O 238.18 32.09 158.79 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General webtpa Medicare Part B O 238.18 32.09 158.79 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General webtpa POS O 238.18 32.09 158.79 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General webtpa PPO O 238.18 32.09 158.79 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General webtpa Workers Comp O 238.18 32.09 158.79 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General worker comp EPO O 238.18 32.09 201.14 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General worker comp HMO O 238.18 32.09 201.14 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General worker comp Medicaid O 238.18 32.09 201.14 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General worker comp Medicare Part A O 238.18 32.09 201.14 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General worker comp Medicare Part B O 238.18 32.09 201.14 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General worker comp POS O 238.18 32.09 201.14 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General worker comp PPO O 238.18 32.09 201.14 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0310 null revCode Laboratory Pathology General worker comp Workers Comp O 238.18 32.09 201.14 201.14 142.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology aetna EPO O 396.22 152.72 229.81 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology aetna HMO O 396.22 152.72 229.81 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology aetna Medicaid O 396.22 152.72 229.81 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology aetna Medicare Part A O 396.22 152.72 229.81 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology aetna Medicare Part B O 396.22 152.72 229.81 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology aetna POS O 396.22 152.72 229.81 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology aetna PPO O 396.22 152.72 229.81 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology aetna Workers Comp O 396.22 152.72 229.81 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology blue cross blue shield EPO O 396.22 152.72 154.53 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology blue cross blue shield HMO O 396.22 152.72 154.53 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology blue cross blue shield Medicaid O 396.22 152.72 154.53 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology blue cross blue shield Medicare Part A O 396.22 152.72 154.53 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology blue cross blue shield Medicare Part B O 396.22 152.72 154.53 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology blue cross blue shield POS O 396.22 152.72 154.53 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology blue cross blue shield PPO O 396.22 152.72 154.53 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology blue cross blue shield Workers Comp O 396.22 152.72 154.53 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology blue cross blue shield - medicare advantage EPO O 396.22 152.72 152.72 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology blue cross blue shield - medicare advantage HMO O 396.22 152.72 152.72 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology blue cross blue shield - medicare advantage Medicaid O 396.22 152.72 152.72 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology blue cross blue shield - medicare advantage Medicare Part A O 396.22 152.72 152.72 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology blue cross blue shield - medicare advantage Medicare Part B O 396.22 152.72 152.72 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology blue cross blue shield - medicare advantage POS O 396.22 152.72 152.72 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology blue cross blue shield - medicare advantage PPO O 396.22 152.72 152.72 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology blue cross blue shield - medicare advantage Workers Comp O 396.22 152.72 152.72 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology cigna EPO O 396.22 152.72 272.46 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology cigna HMO O 396.22 152.72 272.46 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology cigna Medicaid O 396.22 152.72 272.46 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology cigna Medicare Part A O 396.22 152.72 272.46 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology cigna Medicare Part B O 396.22 152.72 272.46 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology cigna POS O 396.22 152.72 272.46 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology cigna PPO O 396.22 152.72 272.46 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology cigna Workers Comp O 396.22 152.72 272.46 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology humana - medicare advantage EPO I 396.22 73.67 396.22 396.22 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology humana - medicare advantage EPO O 396.22 152.72 335.53 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology humana - medicare advantage HMO I 396.22 73.67 396.22 396.22 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology humana - medicare advantage HMO O 396.22 152.72 335.53 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology humana - medicare advantage Medicaid I 396.22 73.67 396.22 396.22 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology humana - medicare advantage Medicaid O 396.22 152.72 335.53 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology humana - medicare advantage Medicare Part A I 396.22 73.67 396.22 396.22 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology humana - medicare advantage Medicare Part A O 396.22 152.72 335.53 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology humana - medicare advantage Medicare Part B I 396.22 73.67 396.22 396.22 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology humana - medicare advantage Medicare Part B O 396.22 152.72 335.53 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology humana - medicare advantage POS I 396.22 73.67 396.22 396.22 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology humana - medicare advantage POS O 396.22 152.72 335.53 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology humana - medicare advantage PPO I 396.22 73.67 396.22 396.22 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology humana - medicare advantage PPO O 396.22 152.72 335.53 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology humana - medicare advantage Workers Comp I 396.22 73.67 396.22 396.22 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology humana - medicare advantage Workers Comp O 396.22 152.72 335.53 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology tricare EPO O 396.22 152.72 419.99 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology tricare HMO O 396.22 152.72 419.99 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology tricare Medicaid O 396.22 152.72 419.99 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology tricare Medicare Part A O 396.22 152.72 419.99 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology tricare Medicare Part B O 396.22 152.72 419.99 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology tricare POS O 396.22 152.72 419.99 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology tricare PPO O 396.22 152.72 419.99 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology tricare Workers Comp O 396.22 152.72 419.99 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology united healthcare EPO O 396.22 152.72 283.02 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology united healthcare HMO O 396.22 152.72 283.02 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology united healthcare Medicaid O 396.22 152.72 283.02 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology united healthcare Medicare Part A O 396.22 152.72 283.02 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology united healthcare Medicare Part B O 396.22 152.72 283.02 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology united healthcare POS O 396.22 152.72 283.02 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology united healthcare PPO O 396.22 152.72 283.02 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology united healthcare Workers Comp O 396.22 152.72 283.02 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology va EPO I 396.22 73.67 73.67 396.22 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology va EPO O 396.22 152.72 377.36 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology va HMO I 396.22 73.67 73.67 396.22 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology va HMO O 396.22 152.72 377.36 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology va Medicaid I 396.22 73.67 73.67 396.22 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology va Medicaid O 396.22 152.72 377.36 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology va Medicare Part A I 396.22 73.67 73.67 396.22 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology va Medicare Part A O 396.22 152.72 377.36 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology va Medicare Part B I 396.22 73.67 73.67 396.22 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology va Medicare Part B O 396.22 152.72 377.36 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology va POS I 396.22 73.67 73.67 396.22 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology va POS O 396.22 152.72 377.36 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology va PPO I 396.22 73.67 73.67 396.22 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology va PPO O 396.22 152.72 377.36 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology va Workers Comp I 396.22 73.67 73.67 396.22 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0312 null revCode Laboratory Pathology Histology va Workers Comp O 396.22 152.72 377.36 419.99 237.73 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General aetna EPO O 316.94 31.41 180.10 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General aetna HMO O 316.94 31.41 180.10 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General aetna Medicaid O 316.94 31.41 180.10 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General aetna Medicare Part A O 316.94 31.41 180.10 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General aetna Medicare Part B O 316.94 31.41 180.10 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General aetna POS O 316.94 31.41 180.10 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General aetna PPO O 316.94 31.41 180.10 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General aetna Workers Comp O 316.94 31.41 180.10 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General aetna - medicare advantage EPO O 316.94 31.41 95.85 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General aetna - medicare advantage HMO O 316.94 31.41 95.85 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General aetna - medicare advantage Medicaid O 316.94 31.41 95.85 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General aetna - medicare advantage Medicare Part A O 316.94 31.41 95.85 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General aetna - medicare advantage Medicare Part B O 316.94 31.41 95.85 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General aetna - medicare advantage POS O 316.94 31.41 95.85 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General aetna - medicare advantage PPO O 316.94 31.41 95.85 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General aetna - medicare advantage Workers Comp O 316.94 31.41 95.85 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General blue cross blue shield EPO O 316.94 31.41 61.44 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General blue cross blue shield HMO O 316.94 31.41 61.44 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General blue cross blue shield Medicaid O 316.94 31.41 61.44 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General blue cross blue shield Medicare Part A O 316.94 31.41 61.44 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General blue cross blue shield Medicare Part B O 316.94 31.41 61.44 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General blue cross blue shield POS O 316.94 31.41 61.44 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General blue cross blue shield PPO O 316.94 31.41 61.44 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General blue cross blue shield Workers Comp O 316.94 31.41 61.44 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General blue cross blue shield - medicare advantage EPO O 316.94 31.41 61.44 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General blue cross blue shield - medicare advantage HMO O 316.94 31.41 61.44 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General blue cross blue shield - medicare advantage Medicaid O 316.94 31.41 61.44 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General blue cross blue shield - medicare advantage Medicare Part A O 316.94 31.41 61.44 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General blue cross blue shield - medicare advantage Medicare Part B O 316.94 31.41 61.44 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General blue cross blue shield - medicare advantage POS O 316.94 31.41 61.44 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General blue cross blue shield - medicare advantage PPO O 316.94 31.41 61.44 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General blue cross blue shield - medicare advantage Workers Comp O 316.94 31.41 61.44 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General cigna EPO I 253.76 56.00 204.77 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General cigna EPO O 316.94 31.41 207.31 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General cigna HMO I 253.76 56.00 204.77 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General cigna HMO O 316.94 31.41 207.31 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General cigna Medicaid I 253.76 56.00 204.77 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General cigna Medicaid O 316.94 31.41 207.31 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General cigna Medicare Part A I 253.76 56.00 204.77 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General cigna Medicare Part A O 316.94 31.41 207.31 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General cigna Medicare Part B I 253.76 56.00 204.77 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General cigna Medicare Part B O 316.94 31.41 207.31 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General cigna POS I 253.76 56.00 204.77 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General cigna POS O 316.94 31.41 207.31 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General cigna PPO I 253.76 56.00 204.77 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General cigna PPO O 316.94 31.41 207.31 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General cigna Workers Comp I 253.76 56.00 204.77 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General cigna Workers Comp O 316.94 31.41 207.31 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General healthchoice EPO O 316.94 31.41 64.17 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General healthchoice HMO O 316.94 31.41 64.17 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General healthchoice Medicaid O 316.94 31.41 64.17 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General healthchoice Medicare Part A O 316.94 31.41 64.17 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General healthchoice Medicare Part B O 316.94 31.41 64.17 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General healthchoice POS O 316.94 31.41 64.17 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General healthchoice PPO O 316.94 31.41 64.17 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General healthchoice Workers Comp O 316.94 31.41 64.17 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General humana - medicare advantage EPO I 253.76 56.00 237.52 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General humana - medicare advantage EPO O 316.94 31.41 96.51 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General humana - medicare advantage HMO I 253.76 56.00 237.52 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General humana - medicare advantage HMO O 316.94 31.41 96.51 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General humana - medicare advantage Medicaid I 253.76 56.00 237.52 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General humana - medicare advantage Medicaid O 316.94 31.41 96.51 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General humana - medicare advantage Medicare Part A I 253.76 56.00 237.52 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General humana - medicare advantage Medicare Part A O 316.94 31.41 96.51 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General humana - medicare advantage Medicare Part B I 253.76 56.00 237.52 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General humana - medicare advantage Medicare Part B O 316.94 31.41 96.51 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General humana - medicare advantage POS I 253.76 56.00 237.52 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General humana - medicare advantage POS O 316.94 31.41 96.51 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General humana - medicare advantage PPO I 253.76 56.00 237.52 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General humana - medicare advantage PPO O 316.94 31.41 96.51 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General humana - medicare advantage Workers Comp I 253.76 56.00 237.52 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General humana - medicare advantage Workers Comp O 316.94 31.41 96.51 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General medica EPO O 316.94 31.41 119.42 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General medica HMO O 316.94 31.41 119.42 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General medica Medicaid O 316.94 31.41 119.42 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General medica Medicare Part A O 316.94 31.41 119.42 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General medica Medicare Part B O 316.94 31.41 119.42 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General medica POS O 316.94 31.41 119.42 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General medica PPO O 316.94 31.41 119.42 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General medica Workers Comp O 316.94 31.41 119.42 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General tricare EPO O 316.94 31.41 89.99 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General tricare HMO O 316.94 31.41 89.99 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General tricare Medicaid O 316.94 31.41 89.99 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General tricare Medicare Part A O 316.94 31.41 89.99 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General tricare Medicare Part B O 316.94 31.41 89.99 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General tricare POS O 316.94 31.41 89.99 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General tricare PPO O 316.94 31.41 89.99 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General tricare Workers Comp O 316.94 31.41 89.99 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare EPO I 253.76 56.00 221.80 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare EPO O 316.94 31.41 232.89 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare HMO I 253.76 56.00 221.80 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare HMO O 316.94 31.41 232.89 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare Medicaid I 253.76 56.00 221.80 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare Medicaid O 316.94 31.41 232.89 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare Medicare Part A I 253.76 56.00 221.80 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare Medicare Part A O 316.94 31.41 232.89 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare Medicare Part B I 253.76 56.00 221.80 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare Medicare Part B O 316.94 31.41 232.89 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare POS I 253.76 56.00 221.80 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare POS O 316.94 31.41 232.89 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare PPO I 253.76 56.00 221.80 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare PPO O 316.94 31.41 232.89 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare Workers Comp I 253.76 56.00 221.80 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare Workers Comp O 316.94 31.41 232.89 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare - medicare advantage EPO O 316.94 31.41 97.31 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare - medicare advantage HMO O 316.94 31.41 97.31 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare - medicare advantage Medicaid O 316.94 31.41 97.31 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare - medicare advantage Medicare Part A O 316.94 31.41 97.31 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare - medicare advantage Medicare Part B O 316.94 31.41 97.31 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare - medicare advantage POS O 316.94 31.41 97.31 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare - medicare advantage PPO O 316.94 31.41 97.31 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General united healthcare - medicare advantage Workers Comp O 316.94 31.41 97.31 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General va EPO I 253.76 56.00 56.00 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General va EPO O 316.94 31.41 31.41 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General va HMO I 253.76 56.00 56.00 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General va HMO O 316.94 31.41 31.41 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General va Medicaid I 253.76 56.00 56.00 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General va Medicaid O 316.94 31.41 31.41 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General va Medicare Part A I 253.76 56.00 56.00 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General va Medicare Part A O 316.94 31.41 31.41 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General va Medicare Part B I 253.76 56.00 56.00 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General va Medicare Part B O 316.94 31.41 31.41 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General va POS I 253.76 56.00 56.00 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General va POS O 316.94 31.41 31.41 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General va PPO I 253.76 56.00 56.00 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General va PPO O 316.94 31.41 31.41 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General va Workers Comp I 253.76 56.00 56.00 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General va Workers Comp O 316.94 31.41 31.41 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General webtpa EPO O 316.94 31.41 273.41 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General webtpa HMO O 316.94 31.41 273.41 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General webtpa Medicaid O 316.94 31.41 273.41 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General webtpa Medicare Part A O 316.94 31.41 273.41 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General webtpa Medicare Part B O 316.94 31.41 273.41 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General webtpa POS O 316.94 31.41 273.41 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General webtpa PPO O 316.94 31.41 273.41 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General webtpa Workers Comp O 316.94 31.41 273.41 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General worker comp EPO I 253.76 56.00 241.68 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General worker comp EPO O 316.94 31.41 100.70 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General worker comp HMO I 253.76 56.00 241.68 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General worker comp HMO O 316.94 31.41 100.70 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General worker comp Medicaid I 253.76 56.00 241.68 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General worker comp Medicaid O 316.94 31.41 100.70 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General worker comp Medicare Part A I 253.76 56.00 241.68 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General worker comp Medicare Part A O 316.94 31.41 100.70 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General worker comp Medicare Part B I 253.76 56.00 241.68 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General worker comp Medicare Part B O 316.94 31.41 100.70 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General worker comp POS I 253.76 56.00 241.68 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General worker comp POS O 316.94 31.41 100.70 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General worker comp PPO I 253.76 56.00 241.68 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General worker comp PPO O 316.94 31.41 100.70 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General worker comp Workers Comp I 253.76 56.00 241.68 241.68 152.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0320 null revCode Radiology Diagnostic General worker comp Workers Comp O 316.94 31.41 100.70 273.41 190.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography blue cross blue shield EPO O 9051.34 1936.18 1936.18 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography blue cross blue shield HMO O 9051.34 1936.18 1936.18 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography blue cross blue shield Medicaid O 9051.34 1936.18 1936.18 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography blue cross blue shield Medicare Part A O 9051.34 1936.18 1936.18 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography blue cross blue shield Medicare Part B O 9051.34 1936.18 1936.18 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography blue cross blue shield POS O 9051.34 1936.18 1936.18 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography blue cross blue shield PPO O 9051.34 1936.18 1936.18 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography blue cross blue shield Workers Comp O 9051.34 1936.18 1936.18 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography blue cross blue shield - medicare advantage EPO O 9051.34 1936.18 2229.51 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography blue cross blue shield - medicare advantage HMO O 9051.34 1936.18 2229.51 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography blue cross blue shield - medicare advantage Medicaid O 9051.34 1936.18 2229.51 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography blue cross blue shield - medicare advantage Medicare Part A O 9051.34 1936.18 2229.51 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography blue cross blue shield - medicare advantage Medicare Part B O 9051.34 1936.18 2229.51 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography blue cross blue shield - medicare advantage POS O 9051.34 1936.18 2229.51 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography blue cross blue shield - medicare advantage PPO O 9051.34 1936.18 2229.51 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography blue cross blue shield - medicare advantage Workers Comp O 9051.34 1936.18 2229.51 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography humana - medicare advantage EPO I 921.56 220.44 552.45 552.45 552.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography humana - medicare advantage EPO O 9051.34 1936.18 2455.02 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography humana - medicare advantage HMO I 921.56 220.44 552.45 552.45 552.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography humana - medicare advantage HMO O 9051.34 1936.18 2455.02 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography humana - medicare advantage Medicaid I 921.56 220.44 552.45 552.45 552.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography humana - medicare advantage Medicaid O 9051.34 1936.18 2455.02 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography humana - medicare advantage Medicare Part A I 921.56 220.44 552.45 552.45 552.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography humana - medicare advantage Medicare Part A O 9051.34 1936.18 2455.02 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography humana - medicare advantage Medicare Part B I 921.56 220.44 552.45 552.45 552.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography humana - medicare advantage Medicare Part B O 9051.34 1936.18 2455.02 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography humana - medicare advantage POS I 921.56 220.44 552.45 552.45 552.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography humana - medicare advantage POS O 9051.34 1936.18 2455.02 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography humana - medicare advantage PPO I 921.56 220.44 552.45 552.45 552.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography humana - medicare advantage PPO O 9051.34 1936.18 2455.02 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography humana - medicare advantage Workers Comp I 921.56 220.44 552.45 552.45 552.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography humana - medicare advantage Workers Comp O 9051.34 1936.18 2455.02 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography tricare EPO O 9051.34 1936.18 2455.02 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography tricare HMO O 9051.34 1936.18 2455.02 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography tricare Medicaid O 9051.34 1936.18 2455.02 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography tricare Medicare Part A O 9051.34 1936.18 2455.02 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography tricare Medicare Part B O 9051.34 1936.18 2455.02 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography tricare POS O 9051.34 1936.18 2455.02 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography tricare PPO O 9051.34 1936.18 2455.02 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography tricare Workers Comp O 9051.34 1936.18 2455.02 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography va EPO I 921.56 220.44 220.44 552.45 552.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography va EPO O 9051.34 1936.18 2534.31 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography va HMO I 921.56 220.44 220.44 552.45 552.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography va HMO O 9051.34 1936.18 2534.31 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography va Medicaid I 921.56 220.44 220.44 552.45 552.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography va Medicaid O 9051.34 1936.18 2534.31 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography va Medicare Part A I 921.56 220.44 220.44 552.45 552.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography va Medicare Part A O 9051.34 1936.18 2534.31 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography va Medicare Part B I 921.56 220.44 220.44 552.45 552.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography va Medicare Part B O 9051.34 1936.18 2534.31 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography va POS I 921.56 220.44 220.44 552.45 552.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography va POS O 9051.34 1936.18 2534.31 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography va PPO I 921.56 220.44 220.44 552.45 552.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography va PPO O 9051.34 1936.18 2534.31 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography va Workers Comp I 921.56 220.44 220.44 552.45 552.94 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0321 null revCode Radiology Diagnostic Angiocardiography va Workers Comp O 9051.34 1936.18 2534.31 2534.31 5430.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography blue cross blue shield EPO O 1252.12 200.59 258.56 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography blue cross blue shield HMO O 1252.12 200.59 258.56 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography blue cross blue shield Medicaid O 1252.12 200.59 258.56 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography blue cross blue shield Medicare Part A O 1252.12 200.59 258.56 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography blue cross blue shield Medicare Part B O 1252.12 200.59 258.56 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography blue cross blue shield POS O 1252.12 200.59 258.56 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography blue cross blue shield PPO O 1252.12 200.59 258.56 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography blue cross blue shield Workers Comp O 1252.12 200.59 258.56 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography blue cross blue shield - medicare advantage EPO O 1252.12 200.59 272.87 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography blue cross blue shield - medicare advantage HMO O 1252.12 200.59 272.87 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography blue cross blue shield - medicare advantage Medicaid O 1252.12 200.59 272.87 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography blue cross blue shield - medicare advantage Medicare Part A O 1252.12 200.59 272.87 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography blue cross blue shield - medicare advantage Medicare Part B O 1252.12 200.59 272.87 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography blue cross blue shield - medicare advantage POS O 1252.12 200.59 272.87 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography blue cross blue shield - medicare advantage PPO O 1252.12 200.59 272.87 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography blue cross blue shield - medicare advantage Workers Comp O 1252.12 200.59 272.87 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography humana - medicare advantage EPO O 1252.12 200.59 338.27 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography humana - medicare advantage HMO O 1252.12 200.59 338.27 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography humana - medicare advantage Medicaid O 1252.12 200.59 338.27 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography humana - medicare advantage Medicare Part A O 1252.12 200.59 338.27 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography humana - medicare advantage Medicare Part B O 1252.12 200.59 338.27 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography humana - medicare advantage POS O 1252.12 200.59 338.27 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography humana - medicare advantage PPO O 1252.12 200.59 338.27 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography humana - medicare advantage Workers Comp O 1252.12 200.59 338.27 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography tricare EPO O 1252.12 200.59 338.27 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography tricare HMO O 1252.12 200.59 338.27 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography tricare Medicaid O 1252.12 200.59 338.27 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography tricare Medicare Part A O 1252.12 200.59 338.27 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography tricare Medicare Part B O 1252.12 200.59 338.27 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography tricare POS O 1252.12 200.59 338.27 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography tricare PPO O 1252.12 200.59 338.27 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography tricare Workers Comp O 1252.12 200.59 338.27 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography va EPO O 1252.12 200.59 200.59 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography va HMO O 1252.12 200.59 200.59 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography va Medicaid O 1252.12 200.59 200.59 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography va Medicare Part A O 1252.12 200.59 200.59 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography va Medicare Part B O 1252.12 200.59 200.59 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography va POS O 1252.12 200.59 200.59 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography va PPO O 1252.12 200.59 200.59 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0322 null revCode Radiology Diagnostic Arthrography va Workers Comp O 1252.12 200.59 200.59 338.27 751.27 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna EPO I 212.58 71.31 123.30 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna EPO O 324.99 3.64 188.49 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna HMO I 212.58 71.31 123.30 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna HMO O 324.99 3.64 188.49 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna Medicaid I 212.58 71.31 123.30 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna Medicaid O 324.99 3.64 188.49 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna Medicare Part A I 212.58 71.31 123.30 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna Medicare Part A O 324.99 3.64 188.49 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna Medicare Part B I 212.58 71.31 123.30 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna Medicare Part B O 324.99 3.64 188.49 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna POS I 212.58 71.31 123.30 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna POS O 324.99 3.64 188.49 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna PPO I 212.58 71.31 123.30 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna PPO O 324.99 3.64 188.49 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna Workers Comp I 212.58 71.31 123.30 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna Workers Comp O 324.99 3.64 188.49 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna - medicare advantage EPO O 324.99 3.64 71.65 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna - medicare advantage HMO O 324.99 3.64 71.65 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna - medicare advantage Medicaid O 324.99 3.64 71.65 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna - medicare advantage Medicare Part A O 324.99 3.64 71.65 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna - medicare advantage Medicare Part B O 324.99 3.64 71.65 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna - medicare advantage POS O 324.99 3.64 71.65 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna - medicare advantage PPO O 324.99 3.64 71.65 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray aetna - medicare advantage Workers Comp O 324.99 3.64 71.65 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray blue cross blue shield EPO O 324.99 3.64 61.44 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray blue cross blue shield HMO O 324.99 3.64 61.44 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray blue cross blue shield Medicaid O 324.99 3.64 61.44 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray blue cross blue shield Medicare Part A O 324.99 3.64 61.44 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray blue cross blue shield Medicare Part B O 324.99 3.64 61.44 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray blue cross blue shield POS O 324.99 3.64 61.44 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray blue cross blue shield PPO O 324.99 3.64 61.44 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray blue cross blue shield Workers Comp O 324.99 3.64 61.44 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray blue cross blue shield - medicare advantage EPO O 324.99 3.64 61.44 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray blue cross blue shield - medicare advantage HMO O 324.99 3.64 61.44 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray blue cross blue shield - medicare advantage Medicaid O 324.99 3.64 61.44 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray blue cross blue shield - medicare advantage Medicare Part A O 324.99 3.64 61.44 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray blue cross blue shield - medicare advantage Medicare Part B O 324.99 3.64 61.44 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray blue cross blue shield - medicare advantage POS O 324.99 3.64 61.44 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray blue cross blue shield - medicare advantage PPO O 324.99 3.64 61.44 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray blue cross blue shield - medicare advantage Workers Comp O 324.99 3.64 61.44 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray cigna EPO I 212.58 71.31 176.45 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray cigna EPO O 324.99 3.64 216.97 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray cigna HMO I 212.58 71.31 176.45 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray cigna HMO O 324.99 3.64 216.97 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray cigna Medicaid I 212.58 71.31 176.45 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray cigna Medicaid O 324.99 3.64 216.97 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray cigna Medicare Part A I 212.58 71.31 176.45 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray cigna Medicare Part A O 324.99 3.64 216.97 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray cigna Medicare Part B I 212.58 71.31 176.45 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray cigna Medicare Part B O 324.99 3.64 216.97 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray cigna POS I 212.58 71.31 176.45 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray cigna POS O 324.99 3.64 216.97 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray cigna PPO I 212.58 71.31 176.45 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray cigna PPO O 324.99 3.64 216.97 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray cigna Workers Comp I 212.58 71.31 176.45 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray cigna Workers Comp O 324.99 3.64 216.97 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray healthchoice EPO O 324.99 3.64 3.64 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray healthchoice HMO O 324.99 3.64 3.64 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray healthchoice Medicaid O 324.99 3.64 3.64 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray healthchoice Medicare Part A O 324.99 3.64 3.64 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray healthchoice Medicare Part B O 324.99 3.64 3.64 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray healthchoice POS O 324.99 3.64 3.64 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray healthchoice PPO O 324.99 3.64 3.64 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray healthchoice Workers Comp O 324.99 3.64 3.64 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray humana - medicare advantage EPO I 212.58 71.31 212.58 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray humana - medicare advantage EPO O 324.99 3.64 71.18 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray humana - medicare advantage HMO I 212.58 71.31 212.58 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray humana - medicare advantage HMO O 324.99 3.64 71.18 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray humana - medicare advantage Medicaid I 212.58 71.31 212.58 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray humana - medicare advantage Medicaid O 324.99 3.64 71.18 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray humana - medicare advantage Medicare Part A I 212.58 71.31 212.58 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray humana - medicare advantage Medicare Part A O 324.99 3.64 71.18 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray humana - medicare advantage Medicare Part B I 212.58 71.31 212.58 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray humana - medicare advantage Medicare Part B O 324.99 3.64 71.18 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray humana - medicare advantage POS I 212.58 71.31 212.58 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray humana - medicare advantage POS O 324.99 3.64 71.18 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray humana - medicare advantage PPO I 212.58 71.31 212.58 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray humana - medicare advantage PPO O 324.99 3.64 71.18 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray humana - medicare advantage Workers Comp I 212.58 71.31 212.58 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray humana - medicare advantage Workers Comp O 324.99 3.64 71.18 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray medica EPO O 324.99 3.64 120.25 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray medica HMO O 324.99 3.64 120.25 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray medica Medicaid O 324.99 3.64 120.25 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray medica Medicare Part A O 324.99 3.64 120.25 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray medica Medicare Part B O 324.99 3.64 120.25 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray medica POS O 324.99 3.64 120.25 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray medica PPO O 324.99 3.64 120.25 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray medica Workers Comp O 324.99 3.64 120.25 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray tricare EPO O 324.99 3.64 70.70 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray tricare HMO O 324.99 3.64 70.70 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray tricare Medicaid O 324.99 3.64 70.70 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray tricare Medicare Part A O 324.99 3.64 70.70 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray tricare Medicare Part B O 324.99 3.64 70.70 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray tricare POS O 324.99 3.64 70.70 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray tricare PPO O 324.99 3.64 70.70 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray tricare Workers Comp O 324.99 3.64 70.70 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare EPO I 212.58 71.31 151.84 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare EPO O 324.99 3.64 232.14 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare HMO I 212.58 71.31 151.84 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare HMO O 324.99 3.64 232.14 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare Medicaid I 212.58 71.31 151.84 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare Medicaid O 324.99 3.64 232.14 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare Medicare Part A I 212.58 71.31 151.84 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare Medicare Part A O 324.99 3.64 232.14 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare Medicare Part B I 212.58 71.31 151.84 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare Medicare Part B O 324.99 3.64 232.14 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare POS I 212.58 71.31 151.84 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare POS O 324.99 3.64 232.14 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare PPO I 212.58 71.31 151.84 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare PPO O 324.99 3.64 232.14 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare Workers Comp I 212.58 71.31 151.84 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare Workers Comp O 324.99 3.64 232.14 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare - medicare advantage EPO O 324.99 3.64 69.69 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare - medicare advantage HMO O 324.99 3.64 69.69 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare - medicare advantage Medicaid O 324.99 3.64 69.69 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare - medicare advantage Medicare Part A O 324.99 3.64 69.69 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare - medicare advantage Medicare Part B O 324.99 3.64 69.69 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare - medicare advantage POS O 324.99 3.64 69.69 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare - medicare advantage PPO O 324.99 3.64 69.69 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray united healthcare - medicare advantage Workers Comp O 324.99 3.64 69.69 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray va EPO I 212.58 71.31 71.31 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray va EPO O 324.99 3.64 71.65 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray va HMO I 212.58 71.31 71.31 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray va HMO O 324.99 3.64 71.65 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray va Medicaid I 212.58 71.31 71.31 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray va Medicaid O 324.99 3.64 71.65 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray va Medicare Part A I 212.58 71.31 71.31 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray va Medicare Part A O 324.99 3.64 71.65 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray va Medicare Part B I 212.58 71.31 71.31 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray va Medicare Part B O 324.99 3.64 71.65 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray va POS I 212.58 71.31 71.31 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray va POS O 324.99 3.64 71.65 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray va PPO I 212.58 71.31 71.31 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray va PPO O 324.99 3.64 71.65 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray va Workers Comp I 212.58 71.31 71.31 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray va Workers Comp O 324.99 3.64 71.65 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray webtpa EPO O 324.99 3.64 216.66 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray webtpa HMO O 324.99 3.64 216.66 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray webtpa Medicaid O 324.99 3.64 216.66 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray webtpa Medicare Part A O 324.99 3.64 216.66 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray webtpa Medicare Part B O 324.99 3.64 216.66 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray webtpa POS O 324.99 3.64 216.66 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray webtpa PPO O 324.99 3.64 216.66 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray webtpa Workers Comp O 324.99 3.64 216.66 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray worker comp EPO I 212.58 71.31 219.36 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray worker comp EPO O 324.99 3.64 232.14 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray worker comp HMO I 212.58 71.31 219.36 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray worker comp HMO O 324.99 3.64 232.14 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray worker comp Medicaid I 212.58 71.31 219.36 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray worker comp Medicaid O 324.99 3.64 232.14 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray worker comp Medicare Part A I 212.58 71.31 219.36 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray worker comp Medicare Part A O 324.99 3.64 232.14 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray worker comp Medicare Part B I 212.58 71.31 219.36 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray worker comp Medicare Part B O 324.99 3.64 232.14 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray worker comp POS I 212.58 71.31 219.36 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray worker comp POS O 324.99 3.64 232.14 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray worker comp PPO I 212.58 71.31 219.36 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray worker comp PPO O 324.99 3.64 232.14 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray worker comp Workers Comp I 212.58 71.31 219.36 219.36 127.55 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0324 null revCode Radiology Diagnostic Chest X-ray worker comp Workers Comp O 324.99 3.64 232.14 232.14 194.99 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0330 null revCode Radiology Therapeutic and/of Chemotherapy Administration General united healthcare EPO O 2058.52 1543.89 1543.89 1543.89 1235.11 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0330 null revCode Radiology Therapeutic and/of Chemotherapy Administration General united healthcare HMO O 2058.52 1543.89 1543.89 1543.89 1235.11 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0330 null revCode Radiology Therapeutic and/of Chemotherapy Administration General united healthcare Medicaid O 2058.52 1543.89 1543.89 1543.89 1235.11 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0330 null revCode Radiology Therapeutic and/of Chemotherapy Administration General united healthcare Medicare Part A O 2058.52 1543.89 1543.89 1543.89 1235.11 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0330 null revCode Radiology Therapeutic and/of Chemotherapy Administration General united healthcare Medicare Part B O 2058.52 1543.89 1543.89 1543.89 1235.11 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0330 null revCode Radiology Therapeutic and/of Chemotherapy Administration General united healthcare POS O 2058.52 1543.89 1543.89 1543.89 1235.11 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0330 null revCode Radiology Therapeutic and/of Chemotherapy Administration General united healthcare PPO O 2058.52 1543.89 1543.89 1543.89 1235.11 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0330 null revCode Radiology Therapeutic and/of Chemotherapy Administration General united healthcare Workers Comp O 2058.52 1543.89 1543.89 1543.89 1235.11 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection aetna EPO O 224.82 26.28 130.40 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection aetna HMO O 224.82 26.28 130.40 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection aetna Medicaid O 224.82 26.28 130.40 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection aetna Medicare Part A O 224.82 26.28 130.40 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection aetna Medicare Part B O 224.82 26.28 130.40 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection aetna POS O 224.82 26.28 130.40 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection aetna PPO O 224.82 26.28 130.40 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection aetna Workers Comp O 224.82 26.28 130.40 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection aetna - medicare advantage EPO O 224.82 26.28 26.28 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection aetna - medicare advantage HMO O 224.82 26.28 26.28 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection aetna - medicare advantage Medicaid O 224.82 26.28 26.28 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection aetna - medicare advantage Medicare Part A O 224.82 26.28 26.28 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection aetna - medicare advantage Medicare Part B O 224.82 26.28 26.28 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection aetna - medicare advantage POS O 224.82 26.28 26.28 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection aetna - medicare advantage PPO O 224.82 26.28 26.28 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection aetna - medicare advantage Workers Comp O 224.82 26.28 26.28 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection blue cross blue shield EPO O 224.82 26.28 51.44 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection blue cross blue shield HMO O 224.82 26.28 51.44 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection blue cross blue shield Medicaid O 224.82 26.28 51.44 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection blue cross blue shield Medicare Part A O 224.82 26.28 51.44 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection blue cross blue shield Medicare Part B O 224.82 26.28 51.44 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection blue cross blue shield POS O 224.82 26.28 51.44 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection blue cross blue shield PPO O 224.82 26.28 51.44 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection blue cross blue shield Workers Comp O 224.82 26.28 51.44 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection blue cross blue shield - medicare advantage EPO O 224.82 26.28 53.78 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection blue cross blue shield - medicare advantage HMO O 224.82 26.28 53.78 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection blue cross blue shield - medicare advantage Medicaid O 224.82 26.28 53.78 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection blue cross blue shield - medicare advantage Medicare Part A O 224.82 26.28 53.78 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection blue cross blue shield - medicare advantage Medicare Part B O 224.82 26.28 53.78 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection blue cross blue shield - medicare advantage POS O 224.82 26.28 53.78 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection blue cross blue shield - medicare advantage PPO O 224.82 26.28 53.78 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection blue cross blue shield - medicare advantage Workers Comp O 224.82 26.28 53.78 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection cigna EPO O 224.82 26.28 150.10 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection cigna HMO O 224.82 26.28 150.10 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection cigna Medicaid O 224.82 26.28 150.10 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection cigna Medicare Part A O 224.82 26.28 150.10 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection cigna Medicare Part B O 224.82 26.28 150.10 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection cigna POS O 224.82 26.28 150.10 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection cigna PPO O 224.82 26.28 150.10 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection cigna Workers Comp O 224.82 26.28 150.10 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection humana - medicare advantage EPO O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection humana - medicare advantage HMO O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection humana - medicare advantage Medicaid O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection humana - medicare advantage Medicare Part A O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection humana - medicare advantage Medicare Part B O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection humana - medicare advantage POS O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection humana - medicare advantage PPO O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection humana - medicare advantage Workers Comp O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection tricare EPO O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection tricare HMO O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection tricare Medicaid O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection tricare Medicare Part A O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection tricare Medicare Part B O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection tricare POS O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection tricare PPO O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection tricare Workers Comp O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection united healthcare EPO O 224.82 26.28 176.89 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection united healthcare HMO O 224.82 26.28 176.89 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection united healthcare Medicaid O 224.82 26.28 176.89 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection united healthcare Medicare Part A O 224.82 26.28 176.89 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection united healthcare Medicare Part B O 224.82 26.28 176.89 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection united healthcare POS O 224.82 26.28 176.89 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection united healthcare PPO O 224.82 26.28 176.89 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection united healthcare Workers Comp O 224.82 26.28 176.89 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection united healthcare - medicare advantage EPO O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection united healthcare - medicare advantage HMO O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection united healthcare - medicare advantage Medicaid O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection united healthcare - medicare advantage Medicare Part A O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection united healthcare - medicare advantage Medicare Part B O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection united healthcare - medicare advantage POS O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection united healthcare - medicare advantage PPO O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection united healthcare - medicare advantage Workers Comp O 224.82 26.28 53.57 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection va EPO O 224.82 26.28 54.88 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection va HMO O 224.82 26.28 54.88 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection va Medicaid O 224.82 26.28 54.88 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection va Medicare Part A O 224.82 26.28 54.88 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection va Medicare Part B O 224.82 26.28 54.88 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection va POS O 224.82 26.28 54.88 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection va PPO O 224.82 26.28 54.88 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection va Workers Comp O 224.82 26.28 54.88 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection webtpa EPO O 224.82 26.28 3168.72 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection webtpa HMO O 224.82 26.28 3168.72 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection webtpa Medicaid O 224.82 26.28 3168.72 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection webtpa Medicare Part A O 224.82 26.28 3168.72 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection webtpa Medicare Part B O 224.82 26.28 3168.72 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection webtpa POS O 224.82 26.28 3168.72 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection webtpa PPO O 224.82 26.28 3168.72 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0331 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection webtpa Workers Comp O 224.82 26.28 3168.72 3168.72 134.89 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy aetna EPO O 933.20 205.21 510.62 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy aetna HMO O 933.20 205.21 510.62 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy aetna Medicaid O 933.20 205.21 510.62 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy aetna Medicare Part A O 933.20 205.21 510.62 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy aetna Medicare Part B O 933.20 205.21 510.62 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy aetna POS O 933.20 205.21 510.62 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy aetna PPO O 933.20 205.21 510.62 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy aetna Workers Comp O 933.20 205.21 510.62 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy aetna - medicare advantage EPO O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy aetna - medicare advantage HMO O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy aetna - medicare advantage Medicaid O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy aetna - medicare advantage Medicare Part A O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy aetna - medicare advantage Medicare Part B O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy aetna - medicare advantage POS O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy aetna - medicare advantage PPO O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy aetna - medicare advantage Workers Comp O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy blue cross blue shield EPO O 933.20 205.21 660.28 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy blue cross blue shield HMO O 933.20 205.21 660.28 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy blue cross blue shield Medicaid O 933.20 205.21 660.28 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy blue cross blue shield Medicare Part A O 933.20 205.21 660.28 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy blue cross blue shield Medicare Part B O 933.20 205.21 660.28 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy blue cross blue shield POS O 933.20 205.21 660.28 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy blue cross blue shield PPO O 933.20 205.21 660.28 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy blue cross blue shield Workers Comp O 933.20 205.21 660.28 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy blue cross blue shield - medicare advantage EPO O 933.20 205.21 585.95 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy blue cross blue shield - medicare advantage HMO O 933.20 205.21 585.95 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy blue cross blue shield - medicare advantage Medicaid O 933.20 205.21 585.95 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy blue cross blue shield - medicare advantage Medicare Part A O 933.20 205.21 585.95 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy blue cross blue shield - medicare advantage Medicare Part B O 933.20 205.21 585.95 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy blue cross blue shield - medicare advantage POS O 933.20 205.21 585.95 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy blue cross blue shield - medicare advantage PPO O 933.20 205.21 585.95 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy blue cross blue shield - medicare advantage Workers Comp O 933.20 205.21 585.95 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy cigna EPO O 933.20 205.21 622.98 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy cigna HMO O 933.20 205.21 622.98 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy cigna Medicaid O 933.20 205.21 622.98 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy cigna Medicare Part A O 933.20 205.21 622.98 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy cigna Medicare Part B O 933.20 205.21 622.98 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy cigna POS O 933.20 205.21 622.98 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy cigna PPO O 933.20 205.21 622.98 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy cigna Workers Comp O 933.20 205.21 622.98 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy humana - medicare advantage EPO O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy humana - medicare advantage HMO O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy humana - medicare advantage Medicaid O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy humana - medicare advantage Medicare Part A O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy humana - medicare advantage Medicare Part B O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy humana - medicare advantage POS O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy humana - medicare advantage PPO O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy humana - medicare advantage Workers Comp O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy tricare EPO O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy tricare HMO O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy tricare Medicaid O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy tricare Medicare Part A O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy tricare Medicare Part B O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy tricare POS O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy tricare PPO O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy tricare Workers Comp O 933.20 205.21 214.04 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy united healthcare EPO O 933.20 205.21 716.28 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy united healthcare HMO O 933.20 205.21 716.28 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy united healthcare Medicaid O 933.20 205.21 716.28 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy united healthcare Medicare Part A O 933.20 205.21 716.28 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy united healthcare Medicare Part B O 933.20 205.21 716.28 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy united healthcare POS O 933.20 205.21 716.28 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy united healthcare PPO O 933.20 205.21 716.28 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy united healthcare Workers Comp O 933.20 205.21 716.28 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy united healthcare - medicare advantage EPO O 933.20 205.21 205.21 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy united healthcare - medicare advantage HMO O 933.20 205.21 205.21 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy united healthcare - medicare advantage Medicaid O 933.20 205.21 205.21 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy united healthcare - medicare advantage Medicare Part A O 933.20 205.21 205.21 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy united healthcare - medicare advantage Medicare Part B O 933.20 205.21 205.21 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy united healthcare - medicare advantage POS O 933.20 205.21 205.21 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy united healthcare - medicare advantage PPO O 933.20 205.21 205.21 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy united healthcare - medicare advantage Workers Comp O 933.20 205.21 205.21 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy va EPO O 933.20 205.21 480.49 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy va HMO O 933.20 205.21 480.49 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy va Medicaid O 933.20 205.21 480.49 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy va Medicare Part A O 933.20 205.21 480.49 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy va Medicare Part B O 933.20 205.21 480.49 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy va POS O 933.20 205.21 480.49 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy va PPO O 933.20 205.21 480.49 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy va Workers Comp O 933.20 205.21 480.49 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy webtpa EPO O 933.20 205.21 1454.16 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy webtpa HMO O 933.20 205.21 1454.16 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy webtpa Medicaid O 933.20 205.21 1454.16 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy webtpa Medicare Part A O 933.20 205.21 1454.16 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy webtpa Medicare Part B O 933.20 205.21 1454.16 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy webtpa POS O 933.20 205.21 1454.16 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy webtpa PPO O 933.20 205.21 1454.16 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy webtpa Workers Comp O 933.20 205.21 1454.16 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy worker comp EPO O 933.20 205.21 628.85 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy worker comp HMO O 933.20 205.21 628.85 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy worker comp Medicaid O 933.20 205.21 628.85 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy worker comp Medicare Part A O 933.20 205.21 628.85 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy worker comp Medicare Part B O 933.20 205.21 628.85 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy worker comp POS O 933.20 205.21 628.85 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy worker comp PPO O 933.20 205.21 628.85 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0333 null revCode Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy worker comp Workers Comp O 933.20 205.21 628.85 1454.16 559.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV aetna EPO O 481.24 83.56 132.33 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV aetna HMO O 481.24 83.56 132.33 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV aetna Medicaid O 481.24 83.56 132.33 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV aetna Medicare Part A O 481.24 83.56 132.33 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV aetna Medicare Part B O 481.24 83.56 132.33 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV aetna POS O 481.24 83.56 132.33 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV aetna PPO O 481.24 83.56 132.33 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV aetna Workers Comp O 481.24 83.56 132.33 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV aetna - medicare advantage EPO O 481.24 83.56 275.21 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV aetna - medicare advantage HMO O 481.24 83.56 275.21 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV aetna - medicare advantage Medicaid O 481.24 83.56 275.21 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV aetna - medicare advantage Medicare Part A O 481.24 83.56 275.21 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV aetna - medicare advantage Medicare Part B O 481.24 83.56 275.21 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV aetna - medicare advantage POS O 481.24 83.56 275.21 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV aetna - medicare advantage PPO O 481.24 83.56 275.21 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV aetna - medicare advantage Workers Comp O 481.24 83.56 275.21 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV blue cross blue shield EPO O 481.24 83.56 104.22 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV blue cross blue shield HMO O 481.24 83.56 104.22 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV blue cross blue shield Medicaid O 481.24 83.56 104.22 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV blue cross blue shield Medicare Part A O 481.24 83.56 104.22 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV blue cross blue shield Medicare Part B O 481.24 83.56 104.22 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV blue cross blue shield POS O 481.24 83.56 104.22 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV blue cross blue shield PPO O 481.24 83.56 104.22 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV blue cross blue shield Workers Comp O 481.24 83.56 104.22 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV blue cross blue shield - medicare advantage EPO O 481.24 83.56 83.56 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV blue cross blue shield - medicare advantage HMO O 481.24 83.56 83.56 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV blue cross blue shield - medicare advantage Medicaid O 481.24 83.56 83.56 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV blue cross blue shield - medicare advantage Medicare Part A O 481.24 83.56 83.56 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV blue cross blue shield - medicare advantage Medicare Part B O 481.24 83.56 83.56 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV blue cross blue shield - medicare advantage POS O 481.24 83.56 83.56 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV blue cross blue shield - medicare advantage PPO O 481.24 83.56 83.56 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV blue cross blue shield - medicare advantage Workers Comp O 481.24 83.56 83.56 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV cigna EPO O 481.24 83.56 331.41 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV cigna HMO O 481.24 83.56 331.41 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV cigna Medicaid O 481.24 83.56 331.41 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV cigna Medicare Part A O 481.24 83.56 331.41 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV cigna Medicare Part B O 481.24 83.56 331.41 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV cigna POS O 481.24 83.56 331.41 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV cigna PPO O 481.24 83.56 331.41 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV cigna Workers Comp O 481.24 83.56 331.41 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV humana - medicare advantage EPO O 481.24 83.56 274.27 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV humana - medicare advantage HMO O 481.24 83.56 274.27 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV humana - medicare advantage Medicaid O 481.24 83.56 274.27 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV humana - medicare advantage Medicare Part A O 481.24 83.56 274.27 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV humana - medicare advantage Medicare Part B O 481.24 83.56 274.27 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV humana - medicare advantage POS O 481.24 83.56 274.27 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV humana - medicare advantage PPO O 481.24 83.56 274.27 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV humana - medicare advantage Workers Comp O 481.24 83.56 274.27 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV tricare EPO O 481.24 83.56 274.27 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV tricare HMO O 481.24 83.56 274.27 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV tricare Medicaid O 481.24 83.56 274.27 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV tricare Medicare Part A O 481.24 83.56 274.27 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV tricare Medicare Part B O 481.24 83.56 274.27 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV tricare POS O 481.24 83.56 274.27 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV tricare PPO O 481.24 83.56 274.27 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV tricare Workers Comp O 481.24 83.56 274.27 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV united healthcare EPO O 481.24 83.56 348.21 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV united healthcare HMO O 481.24 83.56 348.21 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV united healthcare Medicaid O 481.24 83.56 348.21 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV united healthcare Medicare Part A O 481.24 83.56 348.21 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV united healthcare Medicare Part B O 481.24 83.56 348.21 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV united healthcare POS O 481.24 83.56 348.21 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV united healthcare PPO O 481.24 83.56 348.21 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV united healthcare Workers Comp O 481.24 83.56 348.21 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV united healthcare - medicare advantage EPO O 481.24 83.56 269.89 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV united healthcare - medicare advantage HMO O 481.24 83.56 269.89 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV united healthcare - medicare advantage Medicaid O 481.24 83.56 269.89 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV united healthcare - medicare advantage Medicare Part A O 481.24 83.56 269.89 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV united healthcare - medicare advantage Medicare Part B O 481.24 83.56 269.89 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV united healthcare - medicare advantage POS O 481.24 83.56 269.89 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV united healthcare - medicare advantage PPO O 481.24 83.56 269.89 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV united healthcare - medicare advantage Workers Comp O 481.24 83.56 269.89 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV va EPO O 481.24 83.56 127.39 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV va HMO O 481.24 83.56 127.39 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV va Medicaid O 481.24 83.56 127.39 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV va Medicare Part A O 481.24 83.56 127.39 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV va Medicare Part B O 481.24 83.56 127.39 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV va POS O 481.24 83.56 127.39 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV va PPO O 481.24 83.56 127.39 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV va Workers Comp O 481.24 83.56 127.39 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV webtpa EPO O 481.24 83.56 10843.32 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV webtpa HMO O 481.24 83.56 10843.32 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV webtpa Medicaid O 481.24 83.56 10843.32 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV webtpa Medicare Part A O 481.24 83.56 10843.32 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV webtpa Medicare Part B O 481.24 83.56 10843.32 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV webtpa POS O 481.24 83.56 10843.32 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV webtpa PPO O 481.24 83.56 10843.32 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0335 null revCode Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV webtpa Workers Comp O 481.24 83.56 10843.32 10843.32 288.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0340 null revCode Nuclear Medicine General blue cross blue shield EPO O 1708.12 1195.84 1195.84 1195.84 1024.87 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0340 null revCode Nuclear Medicine General blue cross blue shield HMO O 1708.12 1195.84 1195.84 1195.84 1024.87 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0340 null revCode Nuclear Medicine General blue cross blue shield Medicaid O 1708.12 1195.84 1195.84 1195.84 1024.87 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0340 null revCode Nuclear Medicine General blue cross blue shield Medicare Part A O 1708.12 1195.84 1195.84 1195.84 1024.87 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0340 null revCode Nuclear Medicine General blue cross blue shield Medicare Part B O 1708.12 1195.84 1195.84 1195.84 1024.87 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0340 null revCode Nuclear Medicine General blue cross blue shield POS O 1708.12 1195.84 1195.84 1195.84 1024.87 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0340 null revCode Nuclear Medicine General blue cross blue shield PPO O 1708.12 1195.84 1195.84 1195.84 1024.87 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0340 null revCode Nuclear Medicine General blue cross blue shield Workers Comp O 1708.12 1195.84 1195.84 1195.84 1024.87 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic aetna EPO O 5253.36 920.97 2951.89 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic aetna HMO O 5253.36 920.97 2951.89 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic aetna Medicaid O 5253.36 920.97 2951.89 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic aetna Medicare Part A O 5253.36 920.97 2951.89 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic aetna Medicare Part B O 5253.36 920.97 2951.89 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic aetna POS O 5253.36 920.97 2951.89 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic aetna PPO O 5253.36 920.97 2951.89 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic aetna Workers Comp O 5253.36 920.97 2951.89 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic aetna - medicare advantage EPO O 5253.36 920.97 1156.59 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic aetna - medicare advantage HMO O 5253.36 920.97 1156.59 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic aetna - medicare advantage Medicaid O 5253.36 920.97 1156.59 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic aetna - medicare advantage Medicare Part A O 5253.36 920.97 1156.59 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic aetna - medicare advantage Medicare Part B O 5253.36 920.97 1156.59 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic aetna - medicare advantage POS O 5253.36 920.97 1156.59 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic aetna - medicare advantage PPO O 5253.36 920.97 1156.59 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic aetna - medicare advantage Workers Comp O 5253.36 920.97 1156.59 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic blue cross blue shield EPO O 5253.36 920.97 995.51 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic blue cross blue shield HMO O 5253.36 920.97 995.51 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic blue cross blue shield Medicaid O 5253.36 920.97 995.51 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic blue cross blue shield Medicare Part A O 5253.36 920.97 995.51 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic blue cross blue shield Medicare Part B O 5253.36 920.97 995.51 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic blue cross blue shield POS O 5253.36 920.97 995.51 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic blue cross blue shield PPO O 5253.36 920.97 995.51 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic blue cross blue shield Workers Comp O 5253.36 920.97 995.51 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic blue cross blue shield - medicare advantage EPO O 5253.36 920.97 920.97 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic blue cross blue shield - medicare advantage HMO O 5253.36 920.97 920.97 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic blue cross blue shield - medicare advantage Medicaid O 5253.36 920.97 920.97 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic blue cross blue shield - medicare advantage Medicare Part A O 5253.36 920.97 920.97 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic blue cross blue shield - medicare advantage Medicare Part B O 5253.36 920.97 920.97 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic blue cross blue shield - medicare advantage POS O 5253.36 920.97 920.97 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic blue cross blue shield - medicare advantage PPO O 5253.36 920.97 920.97 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic blue cross blue shield - medicare advantage Workers Comp O 5253.36 920.97 920.97 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic cigna EPO O 5253.36 920.97 3507.24 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic cigna HMO O 5253.36 920.97 3507.24 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic cigna Medicaid O 5253.36 920.97 3507.24 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic cigna Medicare Part A O 5253.36 920.97 3507.24 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic cigna Medicare Part B O 5253.36 920.97 3507.24 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic cigna POS O 5253.36 920.97 3507.24 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic cigna PPO O 5253.36 920.97 3507.24 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic cigna Workers Comp O 5253.36 920.97 3507.24 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic humana - medicare advantage EPO O 5253.36 920.97 1156.59 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic humana - medicare advantage HMO O 5253.36 920.97 1156.59 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic humana - medicare advantage Medicaid O 5253.36 920.97 1156.59 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic humana - medicare advantage Medicare Part A O 5253.36 920.97 1156.59 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic humana - medicare advantage Medicare Part B O 5253.36 920.97 1156.59 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic humana - medicare advantage POS O 5253.36 920.97 1156.59 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic humana - medicare advantage PPO O 5253.36 920.97 1156.59 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic humana - medicare advantage Workers Comp O 5253.36 920.97 1156.59 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic tricare EPO O 5253.36 920.97 1127.01 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic tricare HMO O 5253.36 920.97 1127.01 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic tricare Medicaid O 5253.36 920.97 1127.01 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic tricare Medicare Part A O 5253.36 920.97 1127.01 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic tricare Medicare Part B O 5253.36 920.97 1127.01 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic tricare POS O 5253.36 920.97 1127.01 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic tricare PPO O 5253.36 920.97 1127.01 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic tricare Workers Comp O 5253.36 920.97 1127.01 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare EPO I 5003.20 1572.40 2906.52 2906.52 3001.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare EPO O 5253.36 920.97 3752.40 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare HMO I 5003.20 1572.40 2906.52 2906.52 3001.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare HMO O 5253.36 920.97 3752.40 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare Medicaid I 5003.20 1572.40 2906.52 2906.52 3001.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare Medicaid O 5253.36 920.97 3752.40 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare Medicare Part A I 5003.20 1572.40 2906.52 2906.52 3001.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare Medicare Part A O 5253.36 920.97 3752.40 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare Medicare Part B I 5003.20 1572.40 2906.52 2906.52 3001.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare Medicare Part B O 5253.36 920.97 3752.40 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare POS I 5003.20 1572.40 2906.52 2906.52 3001.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare POS O 5253.36 920.97 3752.40 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare PPO I 5003.20 1572.40 2906.52 2906.52 3001.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare PPO O 5253.36 920.97 3752.40 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare Workers Comp I 5003.20 1572.40 2906.52 2906.52 3001.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare Workers Comp O 5253.36 920.97 3752.40 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare - medicare advantage EPO O 5253.36 920.97 1255.91 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare - medicare advantage HMO O 5253.36 920.97 1255.91 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare - medicare advantage Medicaid O 5253.36 920.97 1255.91 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare - medicare advantage Medicare Part A O 5253.36 920.97 1255.91 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare - medicare advantage Medicare Part B O 5253.36 920.97 1255.91 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare - medicare advantage POS O 5253.36 920.97 1255.91 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare - medicare advantage PPO O 5253.36 920.97 1255.91 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic united healthcare - medicare advantage Workers Comp O 5253.36 920.97 1255.91 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic va EPO I 5003.20 1572.40 1572.40 2906.52 3001.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic va EPO O 5253.36 920.97 1156.55 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic va HMO I 5003.20 1572.40 1572.40 2906.52 3001.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic va HMO O 5253.36 920.97 1156.55 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic va Medicaid I 5003.20 1572.40 1572.40 2906.52 3001.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic va Medicaid O 5253.36 920.97 1156.55 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic va Medicare Part A I 5003.20 1572.40 1572.40 2906.52 3001.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic va Medicare Part A O 5253.36 920.97 1156.55 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic va Medicare Part B I 5003.20 1572.40 1572.40 2906.52 3001.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic va Medicare Part B O 5253.36 920.97 1156.55 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic va POS I 5003.20 1572.40 1572.40 2906.52 3001.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic va POS O 5253.36 920.97 1156.55 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic va PPO I 5003.20 1572.40 1572.40 2906.52 3001.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic va PPO O 5253.36 920.97 1156.55 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic va Workers Comp I 5003.20 1572.40 1572.40 2906.52 3001.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic va Workers Comp O 5253.36 920.97 1156.55 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic webtpa EPO O 5253.36 920.97 3805.40 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic webtpa HMO O 5253.36 920.97 3805.40 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic webtpa Medicaid O 5253.36 920.97 3805.40 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic webtpa Medicare Part A O 5253.36 920.97 3805.40 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic webtpa Medicare Part B O 5253.36 920.97 3805.40 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic webtpa POS O 5253.36 920.97 3805.40 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic webtpa PPO O 5253.36 920.97 3805.40 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic webtpa Workers Comp O 5253.36 920.97 3805.40 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic worker comp EPO O 5253.36 920.97 5091.98 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic worker comp HMO O 5253.36 920.97 5091.98 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic worker comp Medicaid O 5253.36 920.97 5091.98 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic worker comp Medicare Part A O 5253.36 920.97 5091.98 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic worker comp Medicare Part B O 5253.36 920.97 5091.98 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic worker comp POS O 5253.36 920.97 5091.98 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic worker comp PPO O 5253.36 920.97 5091.98 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0341 null revCode Nuclear Medicine Diagnostic worker comp Workers Comp O 5253.36 920.97 5091.98 5091.98 3152.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0342 null revCode Nuclear Medicine Therapeutic blue cross blue shield - medicare advantage EPO O 548.70 210.31 494.33 494.33 329.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0342 null revCode Nuclear Medicine Therapeutic blue cross blue shield - medicare advantage HMO O 548.70 210.31 494.33 494.33 329.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0342 null revCode Nuclear Medicine Therapeutic blue cross blue shield - medicare advantage Medicaid O 548.70 210.31 494.33 494.33 329.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0342 null revCode Nuclear Medicine Therapeutic blue cross blue shield - medicare advantage Medicare Part A O 548.70 210.31 494.33 494.33 329.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0342 null revCode Nuclear Medicine Therapeutic blue cross blue shield - medicare advantage Medicare Part B O 548.70 210.31 494.33 494.33 329.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0342 null revCode Nuclear Medicine Therapeutic blue cross blue shield - medicare advantage POS O 548.70 210.31 494.33 494.33 329.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0342 null revCode Nuclear Medicine Therapeutic blue cross blue shield - medicare advantage PPO O 548.70 210.31 494.33 494.33 329.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0342 null revCode Nuclear Medicine Therapeutic blue cross blue shield - medicare advantage Workers Comp O 548.70 210.31 494.33 494.33 329.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0342 null revCode Nuclear Medicine Therapeutic humana - medicare advantage EPO O 548.70 210.31 210.31 494.33 329.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0342 null revCode Nuclear Medicine Therapeutic humana - medicare advantage HMO O 548.70 210.31 210.31 494.33 329.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0342 null revCode Nuclear Medicine Therapeutic humana - medicare advantage Medicaid O 548.70 210.31 210.31 494.33 329.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0342 null revCode Nuclear Medicine Therapeutic humana - medicare advantage Medicare Part A O 548.70 210.31 210.31 494.33 329.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0342 null revCode Nuclear Medicine Therapeutic humana - medicare advantage Medicare Part B O 548.70 210.31 210.31 494.33 329.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0342 null revCode Nuclear Medicine Therapeutic humana - medicare advantage POS O 548.70 210.31 210.31 494.33 329.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0342 null revCode Nuclear Medicine Therapeutic humana - medicare advantage PPO O 548.70 210.31 210.31 494.33 329.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0342 null revCode Nuclear Medicine Therapeutic humana - medicare advantage Workers Comp O 548.70 210.31 210.31 494.33 329.22 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals aetna EPO O 653.33 123.81 367.11 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals aetna HMO O 653.33 123.81 367.11 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals aetna Medicaid O 653.33 123.81 367.11 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals aetna Medicare Part A O 653.33 123.81 367.11 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals aetna Medicare Part B O 653.33 123.81 367.11 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals aetna POS O 653.33 123.81 367.11 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals aetna PPO O 653.33 123.81 367.11 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals aetna Workers Comp O 653.33 123.81 367.11 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals aetna - medicare advantage EPO O 653.33 123.81 367.11 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals aetna - medicare advantage HMO O 653.33 123.81 367.11 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals aetna - medicare advantage Medicaid O 653.33 123.81 367.11 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals aetna - medicare advantage Medicare Part A O 653.33 123.81 367.11 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals aetna - medicare advantage Medicare Part B O 653.33 123.81 367.11 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals aetna - medicare advantage POS O 653.33 123.81 367.11 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals aetna - medicare advantage PPO O 653.33 123.81 367.11 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals aetna - medicare advantage Workers Comp O 653.33 123.81 367.11 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals blue cross blue shield EPO O 653.33 123.81 123.81 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals blue cross blue shield HMO O 653.33 123.81 123.81 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals blue cross blue shield Medicaid O 653.33 123.81 123.81 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals blue cross blue shield Medicare Part A O 653.33 123.81 123.81 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals blue cross blue shield Medicare Part B O 653.33 123.81 123.81 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals blue cross blue shield POS O 653.33 123.81 123.81 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals blue cross blue shield PPO O 653.33 123.81 123.81 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals blue cross blue shield Workers Comp O 653.33 123.81 123.81 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals blue cross blue shield - medicare advantage EPO O 653.33 123.81 123.81 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals blue cross blue shield - medicare advantage HMO O 653.33 123.81 123.81 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals blue cross blue shield - medicare advantage Medicaid O 653.33 123.81 123.81 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals blue cross blue shield - medicare advantage Medicare Part A O 653.33 123.81 123.81 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals blue cross blue shield - medicare advantage Medicare Part B O 653.33 123.81 123.81 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals blue cross blue shield - medicare advantage POS O 653.33 123.81 123.81 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals blue cross blue shield - medicare advantage PPO O 653.33 123.81 123.81 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals blue cross blue shield - medicare advantage Workers Comp O 653.33 123.81 123.81 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals united healthcare EPO I 637.78 195.55 308.06 308.06 382.67 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals united healthcare EPO O 653.33 123.81 466.67 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals united healthcare HMO I 637.78 195.55 308.06 308.06 382.67 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals united healthcare HMO O 653.33 123.81 466.67 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals united healthcare Medicaid I 637.78 195.55 308.06 308.06 382.67 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals united healthcare Medicaid O 653.33 123.81 466.67 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals united healthcare Medicare Part A I 637.78 195.55 308.06 308.06 382.67 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals united healthcare Medicare Part A O 653.33 123.81 466.67 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals united healthcare Medicare Part B I 637.78 195.55 308.06 308.06 382.67 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals united healthcare Medicare Part B O 653.33 123.81 466.67 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals united healthcare POS I 637.78 195.55 308.06 308.06 382.67 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals united healthcare POS O 653.33 123.81 466.67 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals united healthcare PPO I 637.78 195.55 308.06 308.06 382.67 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals united healthcare PPO O 653.33 123.81 466.67 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals united healthcare Workers Comp I 637.78 195.55 308.06 308.06 382.67 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals united healthcare Workers Comp O 653.33 123.81 466.67 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals va EPO I 637.78 195.55 195.55 308.06 382.67 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals va EPO O 653.33 123.81 622.22 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals va HMO I 637.78 195.55 195.55 308.06 382.67 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals va HMO O 653.33 123.81 622.22 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals va Medicaid I 637.78 195.55 195.55 308.06 382.67 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals va Medicaid O 653.33 123.81 622.22 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals va Medicare Part A I 637.78 195.55 195.55 308.06 382.67 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals va Medicare Part A O 653.33 123.81 622.22 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals va Medicare Part B I 637.78 195.55 195.55 308.06 382.67 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals va Medicare Part B O 653.33 123.81 622.22 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals va POS I 637.78 195.55 195.55 308.06 382.67 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals va POS O 653.33 123.81 622.22 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals va PPO I 637.78 195.55 195.55 308.06 382.67 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals va PPO O 653.33 123.81 622.22 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals va Workers Comp I 637.78 195.55 195.55 308.06 382.67 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals va Workers Comp O 653.33 123.81 622.22 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals webtpa EPO O 653.33 123.81 2513.99 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals webtpa HMO O 653.33 123.81 2513.99 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals webtpa Medicaid O 653.33 123.81 2513.99 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals webtpa Medicare Part A O 653.33 123.81 2513.99 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals webtpa Medicare Part B O 653.33 123.81 2513.99 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals webtpa POS O 653.33 123.81 2513.99 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals webtpa PPO O 653.33 123.81 2513.99 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals webtpa Workers Comp O 653.33 123.81 2513.99 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals worker comp EPO O 653.33 123.81 1046.22 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals worker comp HMO O 653.33 123.81 1046.22 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals worker comp Medicaid O 653.33 123.81 1046.22 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals worker comp Medicare Part A O 653.33 123.81 1046.22 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals worker comp Medicare Part B O 653.33 123.81 1046.22 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals worker comp POS O 653.33 123.81 1046.22 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals worker comp PPO O 653.33 123.81 1046.22 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0343 null revCode Nuclear Medicine Diagnostic radiopharmaceuticals worker comp Workers Comp O 653.33 123.81 1046.22 2513.99 392.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0344 null revCode Nuclear Medicine Therapeutic radiopharmaceuticals humana - medicare advantage EPO O 461.89 103.51 103.51 103.51 277.13 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0344 null revCode Nuclear Medicine Therapeutic radiopharmaceuticals humana - medicare advantage HMO O 461.89 103.51 103.51 103.51 277.13 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0344 null revCode Nuclear Medicine Therapeutic radiopharmaceuticals humana - medicare advantage Medicaid O 461.89 103.51 103.51 103.51 277.13 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0344 null revCode Nuclear Medicine Therapeutic radiopharmaceuticals humana - medicare advantage Medicare Part A O 461.89 103.51 103.51 103.51 277.13 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0344 null revCode Nuclear Medicine Therapeutic radiopharmaceuticals humana - medicare advantage Medicare Part B O 461.89 103.51 103.51 103.51 277.13 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0344 null revCode Nuclear Medicine Therapeutic radiopharmaceuticals humana - medicare advantage POS O 461.89 103.51 103.51 103.51 277.13 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0344 null revCode Nuclear Medicine Therapeutic radiopharmaceuticals humana - medicare advantage PPO O 461.89 103.51 103.51 103.51 277.13 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0344 null revCode Nuclear Medicine Therapeutic radiopharmaceuticals humana - medicare advantage Workers Comp O 461.89 103.51 103.51 103.51 277.13 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 035 null ms-drg carotid artery stent procedures with cc humana - medicare advantage EPO I 50323.37 14428.53 14428.53 14428.53 30194.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 035 null ms-drg carotid artery stent procedures with cc humana - medicare advantage HMO I 50323.37 14428.53 14428.53 14428.53 30194.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 035 null ms-drg carotid artery stent procedures with cc humana - medicare advantage Medicaid I 50323.37 14428.53 14428.53 14428.53 30194.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 035 null ms-drg carotid artery stent procedures with cc humana - medicare advantage Medicare Part A I 50323.37 14428.53 14428.53 14428.53 30194.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 035 null ms-drg carotid artery stent procedures with cc humana - medicare advantage Medicare Part B I 50323.37 14428.53 14428.53 14428.53 30194.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 035 null ms-drg carotid artery stent procedures with cc humana - medicare advantage POS I 50323.37 14428.53 14428.53 14428.53 30194.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 035 null ms-drg carotid artery stent procedures with cc humana - medicare advantage PPO I 50323.37 14428.53 14428.53 14428.53 30194.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 035 null ms-drg carotid artery stent procedures with cc humana - medicare advantage Workers Comp I 50323.37 14428.53 14428.53 14428.53 30194.02 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna EPO I 3199.87 815.07 1855.92 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna EPO O 3199.87 326.01 1798.03 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna HMO I 3199.87 815.07 1855.92 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna HMO O 3199.87 326.01 1798.03 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna Medicaid I 3199.87 815.07 1855.92 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna Medicaid O 3199.87 326.01 1798.03 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna Medicare Part A I 3199.87 815.07 1855.92 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna Medicare Part A O 3199.87 326.01 1798.03 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna Medicare Part B I 3199.87 815.07 1855.92 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna Medicare Part B O 3199.87 326.01 1798.03 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna POS I 3199.87 815.07 1855.92 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna POS O 3199.87 326.01 1798.03 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna PPO I 3199.87 815.07 1855.92 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna PPO O 3199.87 326.01 1798.03 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna Workers Comp I 3199.87 815.07 1855.92 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna Workers Comp O 3199.87 326.01 1798.03 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna - medicare advantage EPO O 3199.87 326.01 326.37 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna - medicare advantage HMO O 3199.87 326.01 326.37 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna - medicare advantage Medicaid O 3199.87 326.01 326.37 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna - medicare advantage Medicare Part A O 3199.87 326.01 326.37 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna - medicare advantage Medicare Part B O 3199.87 326.01 326.37 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna - medicare advantage POS O 3199.87 326.01 326.37 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna - medicare advantage PPO O 3199.87 326.01 326.37 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General aetna - medicare advantage Workers Comp O 3199.87 326.01 326.37 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General blue cross blue shield EPO O 3199.87 326.01 546.57 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General blue cross blue shield HMO O 3199.87 326.01 546.57 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General blue cross blue shield Medicaid O 3199.87 326.01 546.57 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General blue cross blue shield Medicare Part A O 3199.87 326.01 546.57 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General blue cross blue shield Medicare Part B O 3199.87 326.01 546.57 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General blue cross blue shield POS O 3199.87 326.01 546.57 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General blue cross blue shield PPO O 3199.87 326.01 546.57 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General blue cross blue shield Workers Comp O 3199.87 326.01 546.57 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General blue cross blue shield - medicare advantage EPO O 3199.87 326.01 549.90 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General blue cross blue shield - medicare advantage HMO O 3199.87 326.01 549.90 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General blue cross blue shield - medicare advantage Medicaid O 3199.87 326.01 549.90 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General blue cross blue shield - medicare advantage Medicare Part A O 3199.87 326.01 549.90 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General blue cross blue shield - medicare advantage Medicare Part B O 3199.87 326.01 549.90 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General blue cross blue shield - medicare advantage POS O 3199.87 326.01 549.90 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General blue cross blue shield - medicare advantage PPO O 3199.87 326.01 549.90 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General blue cross blue shield - medicare advantage Workers Comp O 3199.87 326.01 549.90 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General cigna EPO I 3199.87 815.07 1804.25 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General cigna EPO O 3199.87 326.01 2136.30 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General cigna HMO I 3199.87 815.07 1804.25 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General cigna HMO O 3199.87 326.01 2136.30 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General cigna Medicaid I 3199.87 815.07 1804.25 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General cigna Medicaid O 3199.87 326.01 2136.30 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General cigna Medicare Part A I 3199.87 815.07 1804.25 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General cigna Medicare Part A O 3199.87 326.01 2136.30 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General cigna Medicare Part B I 3199.87 815.07 1804.25 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General cigna Medicare Part B O 3199.87 326.01 2136.30 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General cigna POS I 3199.87 815.07 1804.25 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General cigna POS O 3199.87 326.01 2136.30 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General cigna PPO I 3199.87 815.07 1804.25 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General cigna PPO O 3199.87 326.01 2136.30 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General cigna Workers Comp I 3199.87 815.07 1804.25 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General cigna Workers Comp O 3199.87 326.01 2136.30 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General humana - medicare advantage EPO I 3199.87 815.07 2526.39 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General humana - medicare advantage EPO O 3199.87 326.01 338.27 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General humana - medicare advantage HMO I 3199.87 815.07 2526.39 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General humana - medicare advantage HMO O 3199.87 326.01 338.27 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General humana - medicare advantage Medicaid I 3199.87 815.07 2526.39 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General humana - medicare advantage Medicaid O 3199.87 326.01 338.27 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General humana - medicare advantage Medicare Part A I 3199.87 815.07 2526.39 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General humana - medicare advantage Medicare Part A O 3199.87 326.01 338.27 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General humana - medicare advantage Medicare Part B I 3199.87 815.07 2526.39 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General humana - medicare advantage Medicare Part B O 3199.87 326.01 338.27 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General humana - medicare advantage POS I 3199.87 815.07 2526.39 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General humana - medicare advantage POS O 3199.87 326.01 338.27 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General humana - medicare advantage PPO I 3199.87 815.07 2526.39 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General humana - medicare advantage PPO O 3199.87 326.01 338.27 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General humana - medicare advantage Workers Comp I 3199.87 815.07 2526.39 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General humana - medicare advantage Workers Comp O 3199.87 326.01 338.27 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General tricare EPO O 3199.87 326.01 338.27 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General tricare HMO O 3199.87 326.01 338.27 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General tricare Medicaid O 3199.87 326.01 338.27 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General tricare Medicare Part A O 3199.87 326.01 338.27 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General tricare Medicare Part B O 3199.87 326.01 338.27 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General tricare POS O 3199.87 326.01 338.27 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General tricare PPO O 3199.87 326.01 338.27 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General tricare Workers Comp O 3199.87 326.01 338.27 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General united healthcare EPO O 3199.87 326.01 2285.63 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General united healthcare HMO O 3199.87 326.01 2285.63 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General united healthcare Medicaid O 3199.87 326.01 2285.63 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General united healthcare Medicare Part A O 3199.87 326.01 2285.63 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General united healthcare Medicare Part B O 3199.87 326.01 2285.63 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General united healthcare POS O 3199.87 326.01 2285.63 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General united healthcare PPO O 3199.87 326.01 2285.63 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General united healthcare Workers Comp O 3199.87 326.01 2285.63 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General united healthcare - medicare advantage EPO O 3199.87 326.01 331.51 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General united healthcare - medicare advantage HMO O 3199.87 326.01 331.51 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General united healthcare - medicare advantage Medicaid O 3199.87 326.01 331.51 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General united healthcare - medicare advantage Medicare Part A O 3199.87 326.01 331.51 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General united healthcare - medicare advantage Medicare Part B O 3199.87 326.01 331.51 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General united healthcare - medicare advantage POS O 3199.87 326.01 331.51 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General united healthcare - medicare advantage PPO O 3199.87 326.01 331.51 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General united healthcare - medicare advantage Workers Comp O 3199.87 326.01 331.51 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General va EPO I 3199.87 815.07 815.07 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General va EPO O 3199.87 326.01 326.01 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General va HMO I 3199.87 815.07 815.07 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General va HMO O 3199.87 326.01 326.01 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General va Medicaid I 3199.87 815.07 815.07 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General va Medicaid O 3199.87 326.01 326.01 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General va Medicare Part A I 3199.87 815.07 815.07 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General va Medicare Part A O 3199.87 326.01 326.01 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General va Medicare Part B I 3199.87 815.07 815.07 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General va Medicare Part B O 3199.87 326.01 326.01 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General va POS I 3199.87 815.07 815.07 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General va POS O 3199.87 326.01 326.01 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General va PPO I 3199.87 815.07 815.07 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General va PPO O 3199.87 326.01 326.01 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General va Workers Comp I 3199.87 815.07 815.07 2526.39 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General va Workers Comp O 3199.87 326.01 326.01 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General webtpa EPO O 3199.87 326.01 2032.95 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General webtpa HMO O 3199.87 326.01 2032.95 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General webtpa Medicaid O 3199.87 326.01 2032.95 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General webtpa Medicare Part A O 3199.87 326.01 2032.95 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General webtpa Medicare Part B O 3199.87 326.01 2032.95 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General webtpa POS O 3199.87 326.01 2032.95 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General webtpa PPO O 3199.87 326.01 2032.95 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0350 null revCode CT Scan General webtpa Workers Comp O 3199.87 326.01 2032.95 2285.63 1919.92 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna EPO I 2313.92 668.00 1321.14 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna EPO O 1879.85 97.90 741.10 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna HMO I 2313.92 668.00 1321.14 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna HMO O 1879.85 97.90 741.10 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna Medicaid I 2313.92 668.00 1321.14 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna Medicaid O 1879.85 97.90 741.10 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna Medicare Part A I 2313.92 668.00 1321.14 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna Medicare Part A O 1879.85 97.90 741.10 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna Medicare Part B I 2313.92 668.00 1321.14 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna Medicare Part B O 1879.85 97.90 741.10 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna POS I 2313.92 668.00 1321.14 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna POS O 1879.85 97.90 741.10 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna PPO I 2313.92 668.00 1321.14 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna PPO O 1879.85 97.90 741.10 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna Workers Comp I 2313.92 668.00 1321.14 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna Workers Comp O 1879.85 97.90 741.10 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna - medicare advantage EPO O 1879.85 97.90 192.46 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna - medicare advantage HMO O 1879.85 97.90 192.46 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna - medicare advantage Medicaid O 1879.85 97.90 192.46 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna - medicare advantage Medicare Part A O 1879.85 97.90 192.46 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna - medicare advantage Medicare Part B O 1879.85 97.90 192.46 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna - medicare advantage POS O 1879.85 97.90 192.46 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna - medicare advantage PPO O 1879.85 97.90 192.46 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan aetna - medicare advantage Workers Comp O 1879.85 97.90 192.46 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan blue cross blue shield EPO O 1879.85 97.90 401.11 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan blue cross blue shield HMO O 1879.85 97.90 401.11 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan blue cross blue shield Medicaid O 1879.85 97.90 401.11 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan blue cross blue shield Medicare Part A O 1879.85 97.90 401.11 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan blue cross blue shield Medicare Part B O 1879.85 97.90 401.11 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan blue cross blue shield POS O 1879.85 97.90 401.11 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan blue cross blue shield PPO O 1879.85 97.90 401.11 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan blue cross blue shield Workers Comp O 1879.85 97.90 401.11 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan blue cross blue shield - medicare advantage EPO O 1879.85 97.90 228.66 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan blue cross blue shield - medicare advantage HMO O 1879.85 97.90 228.66 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan blue cross blue shield - medicare advantage Medicaid O 1879.85 97.90 228.66 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan blue cross blue shield - medicare advantage Medicare Part A O 1879.85 97.90 228.66 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan blue cross blue shield - medicare advantage Medicare Part B O 1879.85 97.90 228.66 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan blue cross blue shield - medicare advantage POS O 1879.85 97.90 228.66 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan blue cross blue shield - medicare advantage PPO O 1879.85 97.90 228.66 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan blue cross blue shield - medicare advantage Workers Comp O 1879.85 97.90 228.66 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan cigna EPO I 2313.92 668.00 1817.21 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan cigna HMO I 2313.92 668.00 1817.21 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan cigna Medicaid I 2313.92 668.00 1817.21 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan cigna Medicare Part A I 2313.92 668.00 1817.21 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan cigna Medicare Part B I 2313.92 668.00 1817.21 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan cigna POS I 2313.92 668.00 1817.21 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan cigna PPO I 2313.92 668.00 1817.21 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan cigna Workers Comp I 2313.92 668.00 1817.21 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan humana - medicare advantage EPO I 2313.92 668.00 2313.92 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan humana - medicare advantage EPO O 1879.85 97.90 99.29 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan humana - medicare advantage HMO I 2313.92 668.00 2313.92 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan humana - medicare advantage HMO O 1879.85 97.90 99.29 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan humana - medicare advantage Medicaid I 2313.92 668.00 2313.92 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan humana - medicare advantage Medicaid O 1879.85 97.90 99.29 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan humana - medicare advantage Medicare Part A I 2313.92 668.00 2313.92 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan humana - medicare advantage Medicare Part A O 1879.85 97.90 99.29 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan humana - medicare advantage Medicare Part B I 2313.92 668.00 2313.92 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan humana - medicare advantage Medicare Part B O 1879.85 97.90 99.29 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan humana - medicare advantage POS I 2313.92 668.00 2313.92 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan humana - medicare advantage POS O 1879.85 97.90 99.29 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan humana - medicare advantage PPO I 2313.92 668.00 2313.92 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan humana - medicare advantage PPO O 1879.85 97.90 99.29 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan humana - medicare advantage Workers Comp I 2313.92 668.00 2313.92 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan humana - medicare advantage Workers Comp O 1879.85 97.90 99.29 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan tricare EPO O 1879.85 97.90 99.29 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan tricare HMO O 1879.85 97.90 99.29 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan tricare Medicaid O 1879.85 97.90 99.29 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan tricare Medicare Part A O 1879.85 97.90 99.29 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan tricare Medicare Part B O 1879.85 97.90 99.29 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan tricare POS O 1879.85 97.90 99.29 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan tricare PPO O 1879.85 97.90 99.29 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan tricare Workers Comp O 1879.85 97.90 99.29 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan united healthcare EPO O 1879.85 97.90 1424.09 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan united healthcare HMO O 1879.85 97.90 1424.09 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan united healthcare Medicaid O 1879.85 97.90 1424.09 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan united healthcare Medicare Part A O 1879.85 97.90 1424.09 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan united healthcare Medicare Part B O 1879.85 97.90 1424.09 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan united healthcare POS O 1879.85 97.90 1424.09 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan united healthcare PPO O 1879.85 97.90 1424.09 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan united healthcare Workers Comp O 1879.85 97.90 1424.09 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan united healthcare - medicare advantage EPO O 1879.85 97.90 97.90 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan united healthcare - medicare advantage HMO O 1879.85 97.90 97.90 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan united healthcare - medicare advantage Medicaid O 1879.85 97.90 97.90 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan united healthcare - medicare advantage Medicare Part A O 1879.85 97.90 97.90 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan united healthcare - medicare advantage Medicare Part B O 1879.85 97.90 97.90 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan united healthcare - medicare advantage POS O 1879.85 97.90 97.90 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan united healthcare - medicare advantage PPO O 1879.85 97.90 97.90 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan united healthcare - medicare advantage Workers Comp O 1879.85 97.90 97.90 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan va EPO I 2313.92 668.00 668.00 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan va EPO O 1879.85 97.90 108.04 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan va HMO I 2313.92 668.00 668.00 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan va HMO O 1879.85 97.90 108.04 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan va Medicaid I 2313.92 668.00 668.00 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan va Medicaid O 1879.85 97.90 108.04 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan va Medicare Part A I 2313.92 668.00 668.00 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan va Medicare Part A O 1879.85 97.90 108.04 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan va Medicare Part B I 2313.92 668.00 668.00 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan va Medicare Part B O 1879.85 97.90 108.04 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan va POS I 2313.92 668.00 668.00 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan va POS O 1879.85 97.90 108.04 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan va PPO I 2313.92 668.00 668.00 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan va PPO O 1879.85 97.90 108.04 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan va Workers Comp I 2313.92 668.00 668.00 2313.92 1388.35 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan va Workers Comp O 1879.85 97.90 108.04 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan webtpa EPO O 1879.85 97.90 796.91 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan webtpa HMO O 1879.85 97.90 796.91 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan webtpa Medicaid O 1879.85 97.90 796.91 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan webtpa Medicare Part A O 1879.85 97.90 796.91 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan webtpa Medicare Part B O 1879.85 97.90 796.91 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan webtpa POS O 1879.85 97.90 796.91 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan webtpa PPO O 1879.85 97.90 796.91 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0351 null revCode CT Scan Head scan webtpa Workers Comp O 1879.85 97.90 796.91 1424.09 1127.91 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna EPO I 1673.95 540.61 970.89 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna EPO O 1594.24 47.08 955.75 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna HMO I 1673.95 540.61 970.89 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna HMO O 1594.24 47.08 955.75 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna Medicaid I 1673.95 540.61 970.89 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna Medicaid O 1594.24 47.08 955.75 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna Medicare Part A I 1673.95 540.61 970.89 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna Medicare Part A O 1594.24 47.08 955.75 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna Medicare Part B I 1673.95 540.61 970.89 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna Medicare Part B O 1594.24 47.08 955.75 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna POS I 1673.95 540.61 970.89 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna POS O 1594.24 47.08 955.75 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna PPO I 1673.95 540.61 970.89 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna PPO O 1594.24 47.08 955.75 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna Workers Comp I 1673.95 540.61 970.89 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna Workers Comp O 1594.24 47.08 955.75 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna - medicare advantage EPO O 1594.24 47.08 159.82 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna - medicare advantage HMO O 1594.24 47.08 159.82 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna - medicare advantage Medicaid O 1594.24 47.08 159.82 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna - medicare advantage Medicare Part A O 1594.24 47.08 159.82 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna - medicare advantage Medicare Part B O 1594.24 47.08 159.82 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna - medicare advantage POS O 1594.24 47.08 159.82 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna - medicare advantage PPO O 1594.24 47.08 159.82 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan aetna - medicare advantage Workers Comp O 1594.24 47.08 159.82 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan blue cross blue shield EPO O 1594.24 47.08 405.24 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan blue cross blue shield HMO O 1594.24 47.08 405.24 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan blue cross blue shield Medicaid O 1594.24 47.08 405.24 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan blue cross blue shield Medicare Part A O 1594.24 47.08 405.24 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan blue cross blue shield Medicare Part B O 1594.24 47.08 405.24 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan blue cross blue shield POS O 1594.24 47.08 405.24 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan blue cross blue shield PPO O 1594.24 47.08 405.24 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan blue cross blue shield Workers Comp O 1594.24 47.08 405.24 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan blue cross blue shield - medicare advantage EPO O 1594.24 47.08 454.88 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan blue cross blue shield - medicare advantage HMO O 1594.24 47.08 454.88 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan blue cross blue shield - medicare advantage Medicaid O 1594.24 47.08 454.88 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan blue cross blue shield - medicare advantage Medicare Part A O 1594.24 47.08 454.88 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan blue cross blue shield - medicare advantage Medicare Part B O 1594.24 47.08 454.88 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan blue cross blue shield - medicare advantage POS O 1594.24 47.08 454.88 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan blue cross blue shield - medicare advantage PPO O 1594.24 47.08 454.88 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan blue cross blue shield - medicare advantage Workers Comp O 1594.24 47.08 454.88 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan cigna EPO O 1594.24 47.08 1117.56 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan cigna HMO O 1594.24 47.08 1117.56 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan cigna Medicaid O 1594.24 47.08 1117.56 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan cigna Medicare Part A O 1594.24 47.08 1117.56 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan cigna Medicare Part B O 1594.24 47.08 1117.56 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan cigna POS O 1594.24 47.08 1117.56 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan cigna PPO O 1594.24 47.08 1117.56 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan cigna Workers Comp O 1594.24 47.08 1117.56 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan healthchoice EPO O 1594.24 47.08 47.08 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan healthchoice HMO O 1594.24 47.08 47.08 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan healthchoice Medicaid O 1594.24 47.08 47.08 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan healthchoice Medicare Part A O 1594.24 47.08 47.08 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan healthchoice Medicare Part B O 1594.24 47.08 47.08 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan healthchoice POS O 1594.24 47.08 47.08 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan healthchoice PPO O 1594.24 47.08 47.08 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan healthchoice Workers Comp O 1594.24 47.08 47.08 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan humana - medicare advantage EPO I 1673.95 540.61 1512.97 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan humana - medicare advantage EPO O 1594.24 47.08 99.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan humana - medicare advantage HMO I 1673.95 540.61 1512.97 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan humana - medicare advantage HMO O 1594.24 47.08 99.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan humana - medicare advantage Medicaid I 1673.95 540.61 1512.97 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan humana - medicare advantage Medicaid O 1594.24 47.08 99.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan humana - medicare advantage Medicare Part A I 1673.95 540.61 1512.97 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan humana - medicare advantage Medicare Part A O 1594.24 47.08 99.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan humana - medicare advantage Medicare Part B I 1673.95 540.61 1512.97 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan humana - medicare advantage Medicare Part B O 1594.24 47.08 99.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan humana - medicare advantage POS I 1673.95 540.61 1512.97 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan humana - medicare advantage POS O 1594.24 47.08 99.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan humana - medicare advantage PPO I 1673.95 540.61 1512.97 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan humana - medicare advantage PPO O 1594.24 47.08 99.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan humana - medicare advantage Workers Comp I 1673.95 540.61 1512.97 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan humana - medicare advantage Workers Comp O 1594.24 47.08 99.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan tricare EPO O 1594.24 47.08 99.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan tricare HMO O 1594.24 47.08 99.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan tricare Medicaid O 1594.24 47.08 99.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan tricare Medicare Part A O 1594.24 47.08 99.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan tricare Medicare Part B O 1594.24 47.08 99.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan tricare POS O 1594.24 47.08 99.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan tricare PPO O 1594.24 47.08 99.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan tricare Workers Comp O 1594.24 47.08 99.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare EPO I 1673.95 540.61 1205.62 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare EPO O 1594.24 47.08 1195.68 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare HMO I 1673.95 540.61 1205.62 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare HMO O 1594.24 47.08 1195.68 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare Medicaid I 1673.95 540.61 1205.62 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare Medicaid O 1594.24 47.08 1195.68 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare Medicare Part A I 1673.95 540.61 1205.62 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare Medicare Part A O 1594.24 47.08 1195.68 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare Medicare Part B I 1673.95 540.61 1205.62 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare Medicare Part B O 1594.24 47.08 1195.68 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare POS I 1673.95 540.61 1205.62 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare POS O 1594.24 47.08 1195.68 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare PPO I 1673.95 540.61 1205.62 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare PPO O 1594.24 47.08 1195.68 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare Workers Comp I 1673.95 540.61 1205.62 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare Workers Comp O 1594.24 47.08 1195.68 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare - medicare advantage EPO O 1594.24 47.08 130.36 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare - medicare advantage HMO O 1594.24 47.08 130.36 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare - medicare advantage Medicaid O 1594.24 47.08 130.36 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare - medicare advantage Medicare Part A O 1594.24 47.08 130.36 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare - medicare advantage Medicare Part B O 1594.24 47.08 130.36 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare - medicare advantage POS O 1594.24 47.08 130.36 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare - medicare advantage PPO O 1594.24 47.08 130.36 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan united healthcare - medicare advantage Workers Comp O 1594.24 47.08 130.36 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan va EPO I 1673.95 540.61 540.61 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan va EPO O 1594.24 47.08 119.90 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan va HMO I 1673.95 540.61 540.61 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan va HMO O 1594.24 47.08 119.90 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan va Medicaid I 1673.95 540.61 540.61 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan va Medicaid O 1594.24 47.08 119.90 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan va Medicare Part A I 1673.95 540.61 540.61 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan va Medicare Part A O 1594.24 47.08 119.90 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan va Medicare Part B I 1673.95 540.61 540.61 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan va Medicare Part B O 1594.24 47.08 119.90 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan va POS I 1673.95 540.61 540.61 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan va POS O 1594.24 47.08 119.90 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan va PPO I 1673.95 540.61 540.61 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan va PPO O 1594.24 47.08 119.90 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan va Workers Comp I 1673.95 540.61 540.61 1512.97 1004.37 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan va Workers Comp O 1594.24 47.08 119.90 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan webtpa EPO O 1594.24 47.08 1092.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan webtpa HMO O 1594.24 47.08 1092.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan webtpa Medicaid O 1594.24 47.08 1092.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan webtpa Medicare Part A O 1594.24 47.08 1092.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan webtpa Medicare Part B O 1594.24 47.08 1092.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan webtpa POS O 1594.24 47.08 1092.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan webtpa PPO O 1594.24 47.08 1092.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan webtpa Workers Comp O 1594.24 47.08 1092.29 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan webtpa - medicare advantage EPO O 1594.24 47.08 1382.86 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan webtpa - medicare advantage HMO O 1594.24 47.08 1382.86 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan webtpa - medicare advantage Medicaid O 1594.24 47.08 1382.86 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan webtpa - medicare advantage Medicare Part A O 1594.24 47.08 1382.86 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan webtpa - medicare advantage Medicare Part B O 1594.24 47.08 1382.86 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan webtpa - medicare advantage POS O 1594.24 47.08 1382.86 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan webtpa - medicare advantage PPO O 1594.24 47.08 1382.86 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan webtpa - medicare advantage Workers Comp O 1594.24 47.08 1382.86 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan worker comp EPO O 1594.24 47.08 1068.88 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan worker comp HMO O 1594.24 47.08 1068.88 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan worker comp Medicaid O 1594.24 47.08 1068.88 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan worker comp Medicare Part A O 1594.24 47.08 1068.88 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan worker comp Medicare Part B O 1594.24 47.08 1068.88 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan worker comp POS O 1594.24 47.08 1068.88 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan worker comp PPO O 1594.24 47.08 1068.88 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0352 null revCode CT Scan Body scan worker comp Workers Comp O 1594.24 47.08 1068.88 1382.86 956.54 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 036 null ms-drg carotid artery stent procedures without cc/mcc blue cross blue shield - medicare advantage EPO I 43613.42 11980.78 20336.07 20336.07 26168.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 036 null ms-drg carotid artery stent procedures without cc/mcc blue cross blue shield - medicare advantage HMO I 43613.42 11980.78 20336.07 20336.07 26168.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 036 null ms-drg carotid artery stent procedures without cc/mcc blue cross blue shield - medicare advantage Medicaid I 43613.42 11980.78 20336.07 20336.07 26168.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 036 null ms-drg carotid artery stent procedures without cc/mcc blue cross blue shield - medicare advantage Medicare Part A I 43613.42 11980.78 20336.07 20336.07 26168.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 036 null ms-drg carotid artery stent procedures without cc/mcc blue cross blue shield - medicare advantage Medicare Part B I 43613.42 11980.78 20336.07 20336.07 26168.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 036 null ms-drg carotid artery stent procedures without cc/mcc blue cross blue shield - medicare advantage POS I 43613.42 11980.78 20336.07 20336.07 26168.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 036 null ms-drg carotid artery stent procedures without cc/mcc blue cross blue shield - medicare advantage PPO I 43613.42 11980.78 20336.07 20336.07 26168.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 036 null ms-drg carotid artery stent procedures without cc/mcc blue cross blue shield - medicare advantage Workers Comp I 43613.42 11980.78 20336.07 20336.07 26168.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 036 null ms-drg carotid artery stent procedures without cc/mcc humana - medicare advantage EPO I 43613.42 11980.78 11980.78 20336.07 26168.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 036 null ms-drg carotid artery stent procedures without cc/mcc humana - medicare advantage HMO I 43613.42 11980.78 11980.78 20336.07 26168.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 036 null ms-drg carotid artery stent procedures without cc/mcc humana - medicare advantage Medicaid I 43613.42 11980.78 11980.78 20336.07 26168.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 036 null ms-drg carotid artery stent procedures without cc/mcc humana - medicare advantage Medicare Part A I 43613.42 11980.78 11980.78 20336.07 26168.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 036 null ms-drg carotid artery stent procedures without cc/mcc humana - medicare advantage Medicare Part B I 43613.42 11980.78 11980.78 20336.07 26168.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 036 null ms-drg carotid artery stent procedures without cc/mcc humana - medicare advantage POS I 43613.42 11980.78 11980.78 20336.07 26168.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 036 null ms-drg carotid artery stent procedures without cc/mcc humana - medicare advantage PPO I 43613.42 11980.78 11980.78 20336.07 26168.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 036 null ms-drg carotid artery stent procedures without cc/mcc humana - medicare advantage Workers Comp I 43613.42 11980.78 11980.78 20336.07 26168.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General aetna EPO O 9091.27 1841.32 4789.34 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General aetna HMO O 9091.27 1841.32 4789.34 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General aetna Medicaid O 9091.27 1841.32 4789.34 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General aetna Medicare Part A O 9091.27 1841.32 4789.34 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General aetna Medicare Part B O 9091.27 1841.32 4789.34 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General aetna POS O 9091.27 1841.32 4789.34 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General aetna PPO O 9091.27 1841.32 4789.34 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General aetna Workers Comp O 9091.27 1841.32 4789.34 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General aetna - medicare advantage EPO O 9091.27 1841.32 2494.71 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General aetna - medicare advantage HMO O 9091.27 1841.32 2494.71 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General aetna - medicare advantage Medicaid O 9091.27 1841.32 2494.71 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General aetna - medicare advantage Medicare Part A O 9091.27 1841.32 2494.71 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General aetna - medicare advantage Medicare Part B O 9091.27 1841.32 2494.71 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General aetna - medicare advantage POS O 9091.27 1841.32 2494.71 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General aetna - medicare advantage PPO O 9091.27 1841.32 2494.71 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General aetna - medicare advantage Workers Comp O 9091.27 1841.32 2494.71 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General blue cross blue shield EPO O 9091.27 1841.32 2734.85 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General blue cross blue shield HMO O 9091.27 1841.32 2734.85 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General blue cross blue shield Medicaid O 9091.27 1841.32 2734.85 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General blue cross blue shield Medicare Part A O 9091.27 1841.32 2734.85 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General blue cross blue shield Medicare Part B O 9091.27 1841.32 2734.85 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General blue cross blue shield POS O 9091.27 1841.32 2734.85 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General blue cross blue shield PPO O 9091.27 1841.32 2734.85 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General blue cross blue shield Workers Comp O 9091.27 1841.32 2734.85 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General blue cross blue shield - medicare advantage EPO O 9091.27 1841.32 2227.69 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General blue cross blue shield - medicare advantage HMO O 9091.27 1841.32 2227.69 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General blue cross blue shield - medicare advantage Medicaid O 9091.27 1841.32 2227.69 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General blue cross blue shield - medicare advantage Medicare Part A O 9091.27 1841.32 2227.69 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General blue cross blue shield - medicare advantage Medicare Part B O 9091.27 1841.32 2227.69 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General blue cross blue shield - medicare advantage POS O 9091.27 1841.32 2227.69 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General blue cross blue shield - medicare advantage PPO O 9091.27 1841.32 2227.69 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General blue cross blue shield - medicare advantage Workers Comp O 9091.27 1841.32 2227.69 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General cigna EPO I 1060.08 160.22 1122.93 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General cigna EPO O 9091.27 1841.32 8493.00 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General cigna HMO I 1060.08 160.22 1122.93 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General cigna HMO O 9091.27 1841.32 8493.00 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General cigna Medicaid I 1060.08 160.22 1122.93 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General cigna Medicaid O 9091.27 1841.32 8493.00 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General cigna Medicare Part A I 1060.08 160.22 1122.93 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General cigna Medicare Part A O 9091.27 1841.32 8493.00 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General cigna Medicare Part B I 1060.08 160.22 1122.93 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General cigna Medicare Part B O 9091.27 1841.32 8493.00 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General cigna POS I 1060.08 160.22 1122.93 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General cigna POS O 9091.27 1841.32 8493.00 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General cigna PPO I 1060.08 160.22 1122.93 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General cigna PPO O 9091.27 1841.32 8493.00 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General cigna Workers Comp I 1060.08 160.22 1122.93 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General cigna Workers Comp O 9091.27 1841.32 8493.00 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General geha EPO O 9091.27 1841.32 7560.45 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General geha HMO O 9091.27 1841.32 7560.45 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General geha Medicaid O 9091.27 1841.32 7560.45 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General geha Medicare Part A O 9091.27 1841.32 7560.45 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General geha Medicare Part B O 9091.27 1841.32 7560.45 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General geha POS O 9091.27 1841.32 7560.45 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General geha PPO O 9091.27 1841.32 7560.45 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General geha Workers Comp O 9091.27 1841.32 7560.45 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General humana - medicare advantage EPO I 1060.08 160.22 160.22 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General humana - medicare advantage EPO O 9091.27 1841.32 2455.02 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General humana - medicare advantage HMO I 1060.08 160.22 160.22 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General humana - medicare advantage HMO O 9091.27 1841.32 2455.02 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General humana - medicare advantage Medicaid I 1060.08 160.22 160.22 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General humana - medicare advantage Medicaid O 9091.27 1841.32 2455.02 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General humana - medicare advantage Medicare Part A I 1060.08 160.22 160.22 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General humana - medicare advantage Medicare Part A O 9091.27 1841.32 2455.02 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General humana - medicare advantage Medicare Part B I 1060.08 160.22 160.22 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General humana - medicare advantage Medicare Part B O 9091.27 1841.32 2455.02 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General humana - medicare advantage POS I 1060.08 160.22 160.22 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General humana - medicare advantage POS O 9091.27 1841.32 2455.02 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General humana - medicare advantage PPO I 1060.08 160.22 160.22 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General humana - medicare advantage PPO O 9091.27 1841.32 2455.02 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General humana - medicare advantage Workers Comp I 1060.08 160.22 160.22 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General humana - medicare advantage Workers Comp O 9091.27 1841.32 2455.02 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General tricare EPO O 9091.27 1841.32 2683.82 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General tricare HMO O 9091.27 1841.32 2683.82 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General tricare Medicaid O 9091.27 1841.32 2683.82 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General tricare Medicare Part A O 9091.27 1841.32 2683.82 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General tricare Medicare Part B O 9091.27 1841.32 2683.82 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General tricare POS O 9091.27 1841.32 2683.82 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General tricare PPO O 9091.27 1841.32 2683.82 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General tricare Workers Comp O 9091.27 1841.32 2683.82 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General united healthcare EPO O 9091.27 1841.32 5739.63 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General united healthcare HMO O 9091.27 1841.32 5739.63 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General united healthcare Medicaid O 9091.27 1841.32 5739.63 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General united healthcare Medicare Part A O 9091.27 1841.32 5739.63 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General united healthcare Medicare Part B O 9091.27 1841.32 5739.63 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General united healthcare POS O 9091.27 1841.32 5739.63 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General united healthcare PPO O 9091.27 1841.32 5739.63 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General united healthcare Workers Comp O 9091.27 1841.32 5739.63 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General united healthcare - medicare advantage EPO O 9091.27 1841.32 2455.02 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General united healthcare - medicare advantage HMO O 9091.27 1841.32 2455.02 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General united healthcare - medicare advantage Medicaid O 9091.27 1841.32 2455.02 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General united healthcare - medicare advantage Medicare Part A O 9091.27 1841.32 2455.02 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General united healthcare - medicare advantage Medicare Part B O 9091.27 1841.32 2455.02 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General united healthcare - medicare advantage POS O 9091.27 1841.32 2455.02 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General united healthcare - medicare advantage PPO O 9091.27 1841.32 2455.02 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General united healthcare - medicare advantage Workers Comp O 9091.27 1841.32 2455.02 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General va EPO I 1060.08 160.22 228.75 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General va EPO O 9091.27 1841.32 1841.32 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General va HMO I 1060.08 160.22 228.75 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General va HMO O 9091.27 1841.32 1841.32 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General va Medicaid I 1060.08 160.22 228.75 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General va Medicaid O 9091.27 1841.32 1841.32 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General va Medicare Part A I 1060.08 160.22 228.75 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General va Medicare Part A O 9091.27 1841.32 1841.32 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General va Medicare Part B I 1060.08 160.22 228.75 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General va Medicare Part B O 9091.27 1841.32 1841.32 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General va POS I 1060.08 160.22 228.75 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General va POS O 9091.27 1841.32 1841.32 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General va PPO I 1060.08 160.22 228.75 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General va PPO O 9091.27 1841.32 1841.32 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General va Workers Comp I 1060.08 160.22 228.75 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General va Workers Comp O 9091.27 1841.32 1841.32 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General webtpa EPO O 9091.27 1841.32 13256.75 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General webtpa HMO O 9091.27 1841.32 13256.75 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General webtpa Medicaid O 9091.27 1841.32 13256.75 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General webtpa Medicare Part A O 9091.27 1841.32 13256.75 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General webtpa Medicare Part B O 9091.27 1841.32 13256.75 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General webtpa POS O 9091.27 1841.32 13256.75 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General webtpa PPO O 9091.27 1841.32 13256.75 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General webtpa Workers Comp O 9091.27 1841.32 13256.75 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General worker comp EPO I 1060.08 160.22 585.37 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General worker comp EPO O 9091.27 1841.32 7016.67 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General worker comp HMO I 1060.08 160.22 585.37 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General worker comp HMO O 9091.27 1841.32 7016.67 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General worker comp Medicaid I 1060.08 160.22 585.37 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General worker comp Medicaid O 9091.27 1841.32 7016.67 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General worker comp Medicare Part A I 1060.08 160.22 585.37 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General worker comp Medicare Part A O 9091.27 1841.32 7016.67 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General worker comp Medicare Part B I 1060.08 160.22 585.37 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General worker comp Medicare Part B O 9091.27 1841.32 7016.67 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General worker comp POS I 1060.08 160.22 585.37 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General worker comp POS O 9091.27 1841.32 7016.67 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General worker comp PPO I 1060.08 160.22 585.37 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General worker comp PPO O 9091.27 1841.32 7016.67 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General worker comp Workers Comp I 1060.08 160.22 585.37 1122.93 636.05 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0360 null revCode Operating Room Services General worker comp Workers Comp O 9091.27 1841.32 7016.67 13256.75 5454.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery aetna EPO O 1965.24 271.88 418.92 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery aetna HMO O 1965.24 271.88 418.92 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery aetna Medicaid O 1965.24 271.88 418.92 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery aetna Medicare Part A O 1965.24 271.88 418.92 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery aetna Medicare Part B O 1965.24 271.88 418.92 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery aetna POS O 1965.24 271.88 418.92 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery aetna PPO O 1965.24 271.88 418.92 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery aetna Workers Comp O 1965.24 271.88 418.92 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery aetna - medicare advantage EPO O 1965.24 271.88 355.49 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery aetna - medicare advantage HMO O 1965.24 271.88 355.49 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery aetna - medicare advantage Medicaid O 1965.24 271.88 355.49 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery aetna - medicare advantage Medicare Part A O 1965.24 271.88 355.49 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery aetna - medicare advantage Medicare Part B O 1965.24 271.88 355.49 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery aetna - medicare advantage POS O 1965.24 271.88 355.49 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery aetna - medicare advantage PPO O 1965.24 271.88 355.49 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery aetna - medicare advantage Workers Comp O 1965.24 271.88 355.49 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery blue cross blue shield EPO O 1965.24 271.88 614.10 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery blue cross blue shield HMO O 1965.24 271.88 614.10 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery blue cross blue shield Medicaid O 1965.24 271.88 614.10 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery blue cross blue shield Medicare Part A O 1965.24 271.88 614.10 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery blue cross blue shield Medicare Part B O 1965.24 271.88 614.10 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery blue cross blue shield POS O 1965.24 271.88 614.10 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery blue cross blue shield PPO O 1965.24 271.88 614.10 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery blue cross blue shield Workers Comp O 1965.24 271.88 614.10 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery blue cross blue shield - medicare advantage EPO O 1965.24 271.88 271.88 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery blue cross blue shield - medicare advantage HMO O 1965.24 271.88 271.88 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery blue cross blue shield - medicare advantage Medicaid O 1965.24 271.88 271.88 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery blue cross blue shield - medicare advantage Medicare Part A O 1965.24 271.88 271.88 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery blue cross blue shield - medicare advantage Medicare Part B O 1965.24 271.88 271.88 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery blue cross blue shield - medicare advantage POS O 1965.24 271.88 271.88 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery blue cross blue shield - medicare advantage PPO O 1965.24 271.88 271.88 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery blue cross blue shield - medicare advantage Workers Comp O 1965.24 271.88 271.88 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery cigna EPO I 1952.48 276.63 2461.02 2461.02 1171.49 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery cigna HMO I 1952.48 276.63 2461.02 2461.02 1171.49 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery cigna Medicaid I 1952.48 276.63 2461.02 2461.02 1171.49 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery cigna Medicare Part A I 1952.48 276.63 2461.02 2461.02 1171.49 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery cigna Medicare Part B I 1952.48 276.63 2461.02 2461.02 1171.49 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery cigna POS I 1952.48 276.63 2461.02 2461.02 1171.49 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery cigna PPO I 1952.48 276.63 2461.02 2461.02 1171.49 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery cigna Workers Comp I 1952.48 276.63 2461.02 2461.02 1171.49 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery humana - medicare advantage EPO O 1965.24 271.88 859.60 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery humana - medicare advantage HMO O 1965.24 271.88 859.60 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery humana - medicare advantage Medicaid O 1965.24 271.88 859.60 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery humana - medicare advantage Medicare Part A O 1965.24 271.88 859.60 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery humana - medicare advantage Medicare Part B O 1965.24 271.88 859.60 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery humana - medicare advantage POS O 1965.24 271.88 859.60 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery humana - medicare advantage PPO O 1965.24 271.88 859.60 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery humana - medicare advantage Workers Comp O 1965.24 271.88 859.60 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery tricare EPO O 1965.24 271.88 550.84 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery tricare HMO O 1965.24 271.88 550.84 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery tricare Medicaid O 1965.24 271.88 550.84 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery tricare Medicare Part A O 1965.24 271.88 550.84 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery tricare Medicare Part B O 1965.24 271.88 550.84 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery tricare POS O 1965.24 271.88 550.84 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery tricare PPO O 1965.24 271.88 550.84 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery tricare Workers Comp O 1965.24 271.88 550.84 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery united healthcare EPO O 1965.24 271.88 484.50 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery united healthcare HMO O 1965.24 271.88 484.50 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery united healthcare Medicaid O 1965.24 271.88 484.50 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery united healthcare Medicare Part A O 1965.24 271.88 484.50 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery united healthcare Medicare Part B O 1965.24 271.88 484.50 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery united healthcare POS O 1965.24 271.88 484.50 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery united healthcare PPO O 1965.24 271.88 484.50 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery united healthcare Workers Comp O 1965.24 271.88 484.50 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery united healthcare - medicare advantage EPO O 1965.24 271.88 1162.46 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery united healthcare - medicare advantage HMO O 1965.24 271.88 1162.46 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery united healthcare - medicare advantage Medicaid O 1965.24 271.88 1162.46 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery united healthcare - medicare advantage Medicare Part A O 1965.24 271.88 1162.46 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery united healthcare - medicare advantage Medicare Part B O 1965.24 271.88 1162.46 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery united healthcare - medicare advantage POS O 1965.24 271.88 1162.46 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery united healthcare - medicare advantage PPO O 1965.24 271.88 1162.46 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery united healthcare - medicare advantage Workers Comp O 1965.24 271.88 1162.46 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery va EPO I 1952.48 276.63 276.63 2461.02 1171.49 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery va EPO O 1965.24 271.88 716.99 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery va HMO I 1952.48 276.63 276.63 2461.02 1171.49 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery va HMO O 1965.24 271.88 716.99 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery va Medicaid I 1952.48 276.63 276.63 2461.02 1171.49 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery va Medicaid O 1965.24 271.88 716.99 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery va Medicare Part A I 1952.48 276.63 276.63 2461.02 1171.49 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery va Medicare Part A O 1965.24 271.88 716.99 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery va Medicare Part B I 1952.48 276.63 276.63 2461.02 1171.49 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery va Medicare Part B O 1965.24 271.88 716.99 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery va POS I 1952.48 276.63 276.63 2461.02 1171.49 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery va POS O 1965.24 271.88 716.99 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery va PPO I 1952.48 276.63 276.63 2461.02 1171.49 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery va PPO O 1965.24 271.88 716.99 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery va Workers Comp I 1952.48 276.63 276.63 2461.02 1171.49 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery va Workers Comp O 1965.24 271.88 716.99 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery webtpa EPO O 1965.24 271.88 2026.55 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery webtpa HMO O 1965.24 271.88 2026.55 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery webtpa Medicaid O 1965.24 271.88 2026.55 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery webtpa Medicare Part A O 1965.24 271.88 2026.55 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery webtpa Medicare Part B O 1965.24 271.88 2026.55 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery webtpa POS O 1965.24 271.88 2026.55 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery webtpa PPO O 1965.24 271.88 2026.55 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0361 null revCode Operating Room Services Minor surgery webtpa Workers Comp O 1965.24 271.88 2026.55 2026.55 1179.14 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General aetna EPO I 798.00 181.60 186.37 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General aetna EPO O 645.54 191.58 318.37 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General aetna HMO I 798.00 181.60 186.37 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General aetna HMO O 645.54 191.58 318.37 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General aetna Medicaid I 798.00 181.60 186.37 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General aetna Medicaid O 645.54 191.58 318.37 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General aetna Medicare Part A I 798.00 181.60 186.37 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General aetna Medicare Part A O 645.54 191.58 318.37 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General aetna Medicare Part B I 798.00 181.60 186.37 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General aetna Medicare Part B O 645.54 191.58 318.37 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General aetna POS I 798.00 181.60 186.37 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General aetna POS O 645.54 191.58 318.37 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General aetna PPO I 798.00 181.60 186.37 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General aetna PPO O 645.54 191.58 318.37 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General aetna Workers Comp I 798.00 181.60 186.37 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General aetna Workers Comp O 645.54 191.58 318.37 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General blue cross blue shield EPO O 645.54 191.58 218.09 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General blue cross blue shield HMO O 645.54 191.58 218.09 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General blue cross blue shield Medicaid O 645.54 191.58 218.09 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General blue cross blue shield Medicare Part A O 645.54 191.58 218.09 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General blue cross blue shield Medicare Part B O 645.54 191.58 218.09 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General blue cross blue shield POS O 645.54 191.58 218.09 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General blue cross blue shield PPO O 645.54 191.58 218.09 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General blue cross blue shield Workers Comp O 645.54 191.58 218.09 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General blue cross blue shield - medicare advantage EPO O 645.54 191.58 191.58 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General blue cross blue shield - medicare advantage HMO O 645.54 191.58 191.58 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General blue cross blue shield - medicare advantage Medicaid O 645.54 191.58 191.58 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General blue cross blue shield - medicare advantage Medicare Part A O 645.54 191.58 191.58 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General blue cross blue shield - medicare advantage Medicare Part B O 645.54 191.58 191.58 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General blue cross blue shield - medicare advantage POS O 645.54 191.58 191.58 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General blue cross blue shield - medicare advantage PPO O 645.54 191.58 191.58 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General blue cross blue shield - medicare advantage Workers Comp O 645.54 191.58 191.58 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General cigna EPO I 798.00 181.60 357.17 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General cigna EPO O 645.54 191.58 607.22 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General cigna HMO I 798.00 181.60 357.17 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General cigna HMO O 645.54 191.58 607.22 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General cigna Medicaid I 798.00 181.60 357.17 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General cigna Medicaid O 645.54 191.58 607.22 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General cigna Medicare Part A I 798.00 181.60 357.17 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General cigna Medicare Part A O 645.54 191.58 607.22 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General cigna Medicare Part B I 798.00 181.60 357.17 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General cigna Medicare Part B O 645.54 191.58 607.22 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General cigna POS I 798.00 181.60 357.17 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General cigna POS O 645.54 191.58 607.22 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General cigna PPO I 798.00 181.60 357.17 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General cigna PPO O 645.54 191.58 607.22 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General cigna Workers Comp I 798.00 181.60 357.17 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General cigna Workers Comp O 645.54 191.58 607.22 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General geha EPO O 645.54 191.58 527.09 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General geha HMO O 645.54 191.58 527.09 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General geha Medicaid O 645.54 191.58 527.09 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General geha Medicare Part A O 645.54 191.58 527.09 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General geha Medicare Part B O 645.54 191.58 527.09 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General geha POS O 645.54 191.58 527.09 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General geha PPO O 645.54 191.58 527.09 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General geha Workers Comp O 645.54 191.58 527.09 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General humana - medicare advantage EPO I 798.00 181.60 707.85 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General humana - medicare advantage EPO O 645.54 191.58 591.03 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General humana - medicare advantage HMO I 798.00 181.60 707.85 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General humana - medicare advantage HMO O 645.54 191.58 591.03 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General humana - medicare advantage Medicaid I 798.00 181.60 707.85 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General humana - medicare advantage Medicaid O 645.54 191.58 591.03 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General humana - medicare advantage Medicare Part A I 798.00 181.60 707.85 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General humana - medicare advantage Medicare Part A O 645.54 191.58 591.03 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General humana - medicare advantage Medicare Part B I 798.00 181.60 707.85 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General humana - medicare advantage Medicare Part B O 645.54 191.58 591.03 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General humana - medicare advantage POS I 798.00 181.60 707.85 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General humana - medicare advantage POS O 645.54 191.58 591.03 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General humana - medicare advantage PPO I 798.00 181.60 707.85 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General humana - medicare advantage PPO O 645.54 191.58 591.03 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General humana - medicare advantage Workers Comp I 798.00 181.60 707.85 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General humana - medicare advantage Workers Comp O 645.54 191.58 591.03 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General united healthcare EPO I 798.00 181.60 478.39 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General united healthcare EPO O 645.54 191.58 441.23 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General united healthcare HMO I 798.00 181.60 478.39 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General united healthcare HMO O 645.54 191.58 441.23 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General united healthcare Medicaid I 798.00 181.60 478.39 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General united healthcare Medicaid O 645.54 191.58 441.23 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General united healthcare Medicare Part A I 798.00 181.60 478.39 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General united healthcare Medicare Part A O 645.54 191.58 441.23 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General united healthcare Medicare Part B I 798.00 181.60 478.39 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General united healthcare Medicare Part B O 645.54 191.58 441.23 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General united healthcare POS I 798.00 181.60 478.39 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General united healthcare POS O 645.54 191.58 441.23 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General united healthcare PPO I 798.00 181.60 478.39 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General united healthcare PPO O 645.54 191.58 441.23 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General united healthcare Workers Comp I 798.00 181.60 478.39 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General united healthcare Workers Comp O 645.54 191.58 441.23 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General va EPO I 798.00 181.60 181.60 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General va EPO O 645.54 191.58 645.54 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General va HMO I 798.00 181.60 181.60 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General va HMO O 645.54 191.58 645.54 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General va Medicaid I 798.00 181.60 181.60 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General va Medicaid O 645.54 191.58 645.54 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General va Medicare Part A I 798.00 181.60 181.60 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General va Medicare Part A O 645.54 191.58 645.54 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General va Medicare Part B I 798.00 181.60 181.60 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General va Medicare Part B O 645.54 191.58 645.54 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General va POS I 798.00 181.60 181.60 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General va POS O 645.54 191.58 645.54 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General va PPO I 798.00 181.60 181.60 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General va PPO O 645.54 191.58 645.54 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General va Workers Comp I 798.00 181.60 181.60 707.85 478.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General va Workers Comp O 645.54 191.58 645.54 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General worker comp EPO O 645.54 191.58 484.16 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General worker comp HMO O 645.54 191.58 484.16 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General worker comp Medicaid O 645.54 191.58 484.16 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General worker comp Medicare Part A O 645.54 191.58 484.16 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General worker comp Medicare Part B O 645.54 191.58 484.16 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General worker comp POS O 645.54 191.58 484.16 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General worker comp PPO O 645.54 191.58 484.16 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0370 null revCode Anesthesia General worker comp Workers Comp O 645.54 191.58 484.16 645.54 387.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology aetna EPO I 44.52 7.65 26.90 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology aetna HMO I 44.52 7.65 26.90 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology aetna Medicaid I 44.52 7.65 26.90 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology aetna Medicare Part A I 44.52 7.65 26.90 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology aetna Medicare Part B I 44.52 7.65 26.90 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology aetna POS I 44.52 7.65 26.90 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology aetna PPO I 44.52 7.65 26.90 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology aetna Workers Comp I 44.52 7.65 26.90 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology blue cross blue shield EPO O 44.52 9.62 9.62 15.72 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology blue cross blue shield HMO O 44.52 9.62 9.62 15.72 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology blue cross blue shield Medicaid O 44.52 9.62 9.62 15.72 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology blue cross blue shield Medicare Part A O 44.52 9.62 9.62 15.72 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology blue cross blue shield Medicare Part B O 44.52 9.62 9.62 15.72 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology blue cross blue shield POS O 44.52 9.62 9.62 15.72 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology blue cross blue shield PPO O 44.52 9.62 9.62 15.72 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology blue cross blue shield Workers Comp O 44.52 9.62 9.62 15.72 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology blue cross blue shield - medicare advantage EPO O 44.52 9.62 15.72 15.72 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology blue cross blue shield - medicare advantage HMO O 44.52 9.62 15.72 15.72 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology blue cross blue shield - medicare advantage Medicaid O 44.52 9.62 15.72 15.72 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology blue cross blue shield - medicare advantage Medicare Part A O 44.52 9.62 15.72 15.72 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology blue cross blue shield - medicare advantage Medicare Part B O 44.52 9.62 15.72 15.72 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology blue cross blue shield - medicare advantage POS O 44.52 9.62 15.72 15.72 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology blue cross blue shield - medicare advantage PPO O 44.52 9.62 15.72 15.72 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology blue cross blue shield - medicare advantage Workers Comp O 44.52 9.62 15.72 15.72 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology humana - medicare advantage EPO I 44.52 7.65 44.52 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology humana - medicare advantage HMO I 44.52 7.65 44.52 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology humana - medicare advantage Medicaid I 44.52 7.65 44.52 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology humana - medicare advantage Medicare Part A I 44.52 7.65 44.52 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology humana - medicare advantage Medicare Part B I 44.52 7.65 44.52 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology humana - medicare advantage POS I 44.52 7.65 44.52 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology humana - medicare advantage PPO I 44.52 7.65 44.52 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology humana - medicare advantage Workers Comp I 44.52 7.65 44.52 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology united healthcare EPO I 44.52 7.65 31.80 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology united healthcare HMO I 44.52 7.65 31.80 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology united healthcare Medicaid I 44.52 7.65 31.80 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology united healthcare Medicare Part A I 44.52 7.65 31.80 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology united healthcare Medicare Part B I 44.52 7.65 31.80 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology united healthcare POS I 44.52 7.65 31.80 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology united healthcare PPO I 44.52 7.65 31.80 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology united healthcare Workers Comp I 44.52 7.65 31.80 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology va EPO I 44.52 7.65 7.65 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology va HMO I 44.52 7.65 7.65 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology va Medicaid I 44.52 7.65 7.65 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology va Medicare Part A I 44.52 7.65 7.65 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology va Medicare Part B I 44.52 7.65 7.65 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology va POS I 44.52 7.65 7.65 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology va PPO I 44.52 7.65 7.65 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0371 null revCode Anesthesia Incident to radiology va Workers Comp I 44.52 7.65 7.65 44.52 26.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services aetna EPO O 42.40 19.41 25.02 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services aetna HMO O 42.40 19.41 25.02 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services aetna Medicaid O 42.40 19.41 25.02 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services aetna Medicare Part A O 42.40 19.41 25.02 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services aetna Medicare Part B O 42.40 19.41 25.02 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services aetna POS O 42.40 19.41 25.02 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services aetna PPO O 42.40 19.41 25.02 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services aetna Workers Comp O 42.40 19.41 25.02 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services blue cross blue shield EPO O 42.40 19.41 19.41 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services blue cross blue shield HMO O 42.40 19.41 19.41 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services blue cross blue shield Medicaid O 42.40 19.41 19.41 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services blue cross blue shield Medicare Part A O 42.40 19.41 19.41 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services blue cross blue shield Medicare Part B O 42.40 19.41 19.41 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services blue cross blue shield POS O 42.40 19.41 19.41 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services blue cross blue shield PPO O 42.40 19.41 19.41 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services blue cross blue shield Workers Comp O 42.40 19.41 19.41 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services blue cross blue shield - medicare advantage EPO O 42.40 19.41 27.27 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services blue cross blue shield - medicare advantage HMO O 42.40 19.41 27.27 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services blue cross blue shield - medicare advantage Medicaid O 42.40 19.41 27.27 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services blue cross blue shield - medicare advantage Medicare Part A O 42.40 19.41 27.27 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services blue cross blue shield - medicare advantage Medicare Part B O 42.40 19.41 27.27 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services blue cross blue shield - medicare advantage POS O 42.40 19.41 27.27 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services blue cross blue shield - medicare advantage PPO O 42.40 19.41 27.27 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services blue cross blue shield - medicare advantage Workers Comp O 42.40 19.41 27.27 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services cigna EPO O 42.40 19.41 29.72 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services cigna HMO O 42.40 19.41 29.72 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services cigna Medicaid O 42.40 19.41 29.72 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services cigna Medicare Part A O 42.40 19.41 29.72 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services cigna Medicare Part B O 42.40 19.41 29.72 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services cigna POS O 42.40 19.41 29.72 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services cigna PPO O 42.40 19.41 29.72 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services cigna Workers Comp O 42.40 19.41 29.72 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services va EPO O 42.40 19.41 42.40 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services va HMO O 42.40 19.41 42.40 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services va Medicaid O 42.40 19.41 42.40 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services va Medicare Part A O 42.40 19.41 42.40 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services va Medicare Part B O 42.40 19.41 42.40 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services va POS O 42.40 19.41 42.40 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services va PPO O 42.40 19.41 42.40 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0372 null revCode Anesthesia incident to Other Diagnostic services va Workers Comp O 42.40 19.41 42.40 42.40 25.44 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 038 null ms-drg extracranial procedures with cc humana - medicare advantage EPO I 31824.37 9969.85 9969.85 9969.85 19094.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 038 null ms-drg extracranial procedures with cc humana - medicare advantage HMO I 31824.37 9969.85 9969.85 9969.85 19094.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 038 null ms-drg extracranial procedures with cc humana - medicare advantage Medicaid I 31824.37 9969.85 9969.85 9969.85 19094.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 038 null ms-drg extracranial procedures with cc humana - medicare advantage Medicare Part A I 31824.37 9969.85 9969.85 9969.85 19094.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 038 null ms-drg extracranial procedures with cc humana - medicare advantage Medicare Part B I 31824.37 9969.85 9969.85 9969.85 19094.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 038 null ms-drg extracranial procedures with cc humana - medicare advantage POS I 31824.37 9969.85 9969.85 9969.85 19094.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 038 null ms-drg extracranial procedures with cc humana - medicare advantage PPO I 31824.37 9969.85 9969.85 9969.85 19094.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 038 null ms-drg extracranial procedures with cc humana - medicare advantage Workers Comp I 31824.37 9969.85 9969.85 9969.85 19094.62 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc blue cross blue shield EPO I 25973.02 7469.73 9339.77 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc blue cross blue shield HMO I 25973.02 7469.73 9339.77 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc blue cross blue shield Medicaid I 25973.02 7469.73 9339.77 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc blue cross blue shield Medicare Part A I 25973.02 7469.73 9339.77 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc blue cross blue shield Medicare Part B I 25973.02 7469.73 9339.77 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc blue cross blue shield POS I 25973.02 7469.73 9339.77 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc blue cross blue shield PPO I 25973.02 7469.73 9339.77 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc blue cross blue shield Workers Comp I 25973.02 7469.73 9339.77 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc humana - medicare advantage EPO I 25973.02 7469.73 7469.73 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc humana - medicare advantage HMO I 25973.02 7469.73 7469.73 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc humana - medicare advantage Medicaid I 25973.02 7469.73 7469.73 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc humana - medicare advantage Medicare Part A I 25973.02 7469.73 7469.73 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc humana - medicare advantage Medicare Part B I 25973.02 7469.73 7469.73 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc humana - medicare advantage POS I 25973.02 7469.73 7469.73 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc humana - medicare advantage PPO I 25973.02 7469.73 7469.73 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc humana - medicare advantage Workers Comp I 25973.02 7469.73 7469.73 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc va EPO I 25973.02 7469.73 7515.30 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc va HMO I 25973.02 7469.73 7515.30 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc va Medicaid I 25973.02 7469.73 7515.30 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc va Medicare Part A I 25973.02 7469.73 7515.30 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc va Medicare Part B I 25973.02 7469.73 7515.30 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc va POS I 25973.02 7469.73 7515.30 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc va PPO I 25973.02 7469.73 7515.30 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 039 null ms-drg extracranial procedures without cc/mcc va Workers Comp I 25973.02 7469.73 7515.30 9339.77 15583.81 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General aetna - medicare advantage EPO O 713.43 188.35 188.35 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General aetna - medicare advantage HMO O 713.43 188.35 188.35 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General aetna - medicare advantage Medicaid O 713.43 188.35 188.35 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General aetna - medicare advantage Medicare Part A O 713.43 188.35 188.35 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General aetna - medicare advantage Medicare Part B O 713.43 188.35 188.35 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General aetna - medicare advantage POS O 713.43 188.35 188.35 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General aetna - medicare advantage PPO O 713.43 188.35 188.35 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General aetna - medicare advantage Workers Comp O 713.43 188.35 188.35 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General blue cross blue shield EPO O 713.43 188.35 574.90 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General blue cross blue shield HMO O 713.43 188.35 574.90 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General blue cross blue shield Medicaid O 713.43 188.35 574.90 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General blue cross blue shield Medicare Part A O 713.43 188.35 574.90 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General blue cross blue shield Medicare Part B O 713.43 188.35 574.90 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General blue cross blue shield POS O 713.43 188.35 574.90 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General blue cross blue shield PPO O 713.43 188.35 574.90 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General blue cross blue shield Workers Comp O 713.43 188.35 574.90 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General blue cross blue shield - medicare advantage EPO O 713.43 188.35 462.20 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General blue cross blue shield - medicare advantage HMO O 713.43 188.35 462.20 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General blue cross blue shield - medicare advantage Medicaid O 713.43 188.35 462.20 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General blue cross blue shield - medicare advantage Medicare Part A O 713.43 188.35 462.20 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General blue cross blue shield - medicare advantage Medicare Part B O 713.43 188.35 462.20 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General blue cross blue shield - medicare advantage POS O 713.43 188.35 462.20 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General blue cross blue shield - medicare advantage PPO O 713.43 188.35 462.20 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General blue cross blue shield - medicare advantage Workers Comp O 713.43 188.35 462.20 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General cigna EPO I 714.50 139.98 505.60 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General cigna HMO I 714.50 139.98 505.60 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General cigna Medicaid I 714.50 139.98 505.60 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General cigna Medicare Part A I 714.50 139.98 505.60 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General cigna Medicare Part B I 714.50 139.98 505.60 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General cigna POS I 714.50 139.98 505.60 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General cigna PPO I 714.50 139.98 505.60 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General cigna Workers Comp I 714.50 139.98 505.60 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General humana - medicare advantage EPO I 714.50 139.98 220.37 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General humana - medicare advantage EPO O 713.43 188.35 262.76 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General humana - medicare advantage HMO I 714.50 139.98 220.37 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General humana - medicare advantage HMO O 713.43 188.35 262.76 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General humana - medicare advantage Medicaid I 714.50 139.98 220.37 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General humana - medicare advantage Medicaid O 713.43 188.35 262.76 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General humana - medicare advantage Medicare Part A I 714.50 139.98 220.37 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General humana - medicare advantage Medicare Part A O 713.43 188.35 262.76 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General humana - medicare advantage Medicare Part B I 714.50 139.98 220.37 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General humana - medicare advantage Medicare Part B O 713.43 188.35 262.76 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General humana - medicare advantage POS I 714.50 139.98 220.37 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General humana - medicare advantage POS O 713.43 188.35 262.76 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General humana - medicare advantage PPO I 714.50 139.98 220.37 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General humana - medicare advantage PPO O 713.43 188.35 262.76 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General humana - medicare advantage Workers Comp I 714.50 139.98 220.37 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General humana - medicare advantage Workers Comp O 713.43 188.35 262.76 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General tricare EPO O 713.43 188.35 188.35 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General tricare HMO O 713.43 188.35 188.35 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General tricare Medicaid O 713.43 188.35 188.35 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General tricare Medicare Part A O 713.43 188.35 188.35 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General tricare Medicare Part B O 713.43 188.35 188.35 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General tricare POS O 713.43 188.35 188.35 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General tricare PPO O 713.43 188.35 188.35 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General tricare Workers Comp O 713.43 188.35 188.35 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General va EPO I 714.50 139.98 139.98 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General va EPO O 713.43 188.35 665.38 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General va HMO I 714.50 139.98 139.98 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General va HMO O 713.43 188.35 665.38 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General va Medicaid I 714.50 139.98 139.98 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General va Medicaid O 713.43 188.35 665.38 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General va Medicare Part A I 714.50 139.98 139.98 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General va Medicare Part A O 713.43 188.35 665.38 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General va Medicare Part B I 714.50 139.98 139.98 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General va Medicare Part B O 713.43 188.35 665.38 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General va POS I 714.50 139.98 139.98 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General va POS O 713.43 188.35 665.38 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General va PPO I 714.50 139.98 139.98 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General va PPO O 713.43 188.35 665.38 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General va Workers Comp I 714.50 139.98 139.98 505.60 428.70 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0390 null revCode Administration Processing and Storage for Blood and Blood Components General va Workers Comp O 713.43 188.35 665.38 665.38 428.06 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) aetna EPO O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) aetna HMO O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) aetna Medicaid O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) aetna Medicare Part A O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) aetna Medicare Part B O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) aetna POS O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) aetna PPO O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) aetna Workers Comp O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) aetna - medicare advantage EPO O 463.00 280.77 351.65 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) aetna - medicare advantage HMO O 463.00 280.77 351.65 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) aetna - medicare advantage Medicaid O 463.00 280.77 351.65 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) aetna - medicare advantage Medicare Part A O 463.00 280.77 351.65 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) aetna - medicare advantage Medicare Part B O 463.00 280.77 351.65 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) aetna - medicare advantage POS O 463.00 280.77 351.65 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) aetna - medicare advantage PPO O 463.00 280.77 351.65 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) aetna - medicare advantage Workers Comp O 463.00 280.77 351.65 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) blue cross blue shield EPO O 463.00 280.77 304.77 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) blue cross blue shield HMO O 463.00 280.77 304.77 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) blue cross blue shield Medicaid O 463.00 280.77 304.77 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) blue cross blue shield Medicare Part A O 463.00 280.77 304.77 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) blue cross blue shield Medicare Part B O 463.00 280.77 304.77 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) blue cross blue shield POS O 463.00 280.77 304.77 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) blue cross blue shield PPO O 463.00 280.77 304.77 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) blue cross blue shield Workers Comp O 463.00 280.77 304.77 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) blue cross blue shield - medicare advantage EPO O 463.00 280.77 280.77 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) blue cross blue shield - medicare advantage HMO O 463.00 280.77 280.77 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) blue cross blue shield - medicare advantage Medicaid O 463.00 280.77 280.77 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) blue cross blue shield - medicare advantage Medicare Part A O 463.00 280.77 280.77 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) blue cross blue shield - medicare advantage Medicare Part B O 463.00 280.77 280.77 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) blue cross blue shield - medicare advantage POS O 463.00 280.77 280.77 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) blue cross blue shield - medicare advantage PPO O 463.00 280.77 280.77 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) blue cross blue shield - medicare advantage Workers Comp O 463.00 280.77 280.77 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) humana - medicare advantage EPO O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) humana - medicare advantage HMO O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) humana - medicare advantage Medicaid O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) humana - medicare advantage Medicare Part A O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) humana - medicare advantage Medicare Part B O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) humana - medicare advantage POS O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) humana - medicare advantage PPO O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) humana - medicare advantage Workers Comp O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) tricare EPO O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) tricare HMO O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) tricare Medicaid O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) tricare Medicare Part A O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) tricare Medicare Part B O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) tricare POS O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) tricare PPO O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) tricare Workers Comp O 463.00 280.77 343.76 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) va EPO I 490.78 109.96 109.96 109.96 294.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) va EPO O 463.00 280.77 407.32 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) va HMO I 490.78 109.96 109.96 109.96 294.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) va HMO O 463.00 280.77 407.32 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) va Medicaid I 490.78 109.96 109.96 109.96 294.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) va Medicaid O 463.00 280.77 407.32 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) va Medicare Part A I 490.78 109.96 109.96 109.96 294.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) va Medicare Part A O 463.00 280.77 407.32 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) va Medicare Part B I 490.78 109.96 109.96 109.96 294.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) va Medicare Part B O 463.00 280.77 407.32 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) va POS I 490.78 109.96 109.96 109.96 294.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) va POS O 463.00 280.77 407.32 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) va PPO I 490.78 109.96 109.96 109.96 294.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) va PPO O 463.00 280.77 407.32 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) va Workers Comp I 490.78 109.96 109.96 109.96 294.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0391 null revCode Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions) va Workers Comp O 463.00 280.77 407.32 407.32 277.80 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography aetna - medicare advantage EPO O 253.34 80.51 82.93 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography aetna - medicare advantage HMO O 253.34 80.51 82.93 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography aetna - medicare advantage Medicaid O 253.34 80.51 82.93 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography aetna - medicare advantage Medicare Part A O 253.34 80.51 82.93 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography aetna - medicare advantage Medicare Part B O 253.34 80.51 82.93 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography aetna - medicare advantage POS O 253.34 80.51 82.93 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography aetna - medicare advantage PPO O 253.34 80.51 82.93 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography aetna - medicare advantage Workers Comp O 253.34 80.51 82.93 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography blue cross blue shield EPO O 253.34 80.51 107.77 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography blue cross blue shield HMO O 253.34 80.51 107.77 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography blue cross blue shield Medicaid O 253.34 80.51 107.77 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography blue cross blue shield Medicare Part A O 253.34 80.51 107.77 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography blue cross blue shield Medicare Part B O 253.34 80.51 107.77 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography blue cross blue shield POS O 253.34 80.51 107.77 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography blue cross blue shield PPO O 253.34 80.51 107.77 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography blue cross blue shield Workers Comp O 253.34 80.51 107.77 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography blue cross blue shield - medicare advantage EPO O 253.34 80.51 115.62 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography blue cross blue shield - medicare advantage HMO O 253.34 80.51 115.62 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography blue cross blue shield - medicare advantage Medicaid O 253.34 80.51 115.62 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography blue cross blue shield - medicare advantage Medicare Part A O 253.34 80.51 115.62 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography blue cross blue shield - medicare advantage Medicare Part B O 253.34 80.51 115.62 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography blue cross blue shield - medicare advantage POS O 253.34 80.51 115.62 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography blue cross blue shield - medicare advantage PPO O 253.34 80.51 115.62 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography blue cross blue shield - medicare advantage Workers Comp O 253.34 80.51 115.62 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography humana - medicare advantage EPO O 253.34 80.51 80.51 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography humana - medicare advantage HMO O 253.34 80.51 80.51 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography humana - medicare advantage Medicaid O 253.34 80.51 80.51 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography humana - medicare advantage Medicare Part A O 253.34 80.51 80.51 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography humana - medicare advantage Medicare Part B O 253.34 80.51 80.51 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography humana - medicare advantage POS O 253.34 80.51 80.51 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography humana - medicare advantage PPO O 253.34 80.51 80.51 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography humana - medicare advantage Workers Comp O 253.34 80.51 80.51 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography tricare EPO O 253.34 80.51 93.39 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography tricare HMO O 253.34 80.51 93.39 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography tricare Medicaid O 253.34 80.51 93.39 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography tricare Medicare Part A O 253.34 80.51 93.39 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography tricare Medicare Part B O 253.34 80.51 93.39 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography tricare POS O 253.34 80.51 93.39 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography tricare PPO O 253.34 80.51 93.39 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography tricare Workers Comp O 253.34 80.51 93.39 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography united healthcare EPO O 253.34 80.51 186.43 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography united healthcare HMO O 253.34 80.51 186.43 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography united healthcare Medicaid O 253.34 80.51 186.43 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography united healthcare Medicare Part A O 253.34 80.51 186.43 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography united healthcare Medicare Part B O 253.34 80.51 186.43 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography united healthcare POS O 253.34 80.51 186.43 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography united healthcare PPO O 253.34 80.51 186.43 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography united healthcare Workers Comp O 253.34 80.51 186.43 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography united healthcare - medicare advantage EPO O 253.34 80.51 82.10 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography united healthcare - medicare advantage HMO O 253.34 80.51 82.10 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography united healthcare - medicare advantage Medicaid O 253.34 80.51 82.10 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography united healthcare - medicare advantage Medicare Part A O 253.34 80.51 82.10 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography united healthcare - medicare advantage Medicare Part B O 253.34 80.51 82.10 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography united healthcare - medicare advantage POS O 253.34 80.51 82.10 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography united healthcare - medicare advantage PPO O 253.34 80.51 82.10 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography united healthcare - medicare advantage Workers Comp O 253.34 80.51 82.10 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography va EPO O 253.34 80.51 91.73 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography va HMO O 253.34 80.51 91.73 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography va Medicaid O 253.34 80.51 91.73 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography va Medicare Part A O 253.34 80.51 91.73 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography va Medicare Part B O 253.34 80.51 91.73 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography va POS O 253.34 80.51 91.73 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography va PPO O 253.34 80.51 91.73 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography va Workers Comp O 253.34 80.51 91.73 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography webtpa EPO O 253.34 80.51 177.87 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography webtpa HMO O 253.34 80.51 177.87 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography webtpa Medicaid O 253.34 80.51 177.87 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography webtpa Medicare Part A O 253.34 80.51 177.87 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography webtpa Medicare Part B O 253.34 80.51 177.87 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography webtpa POS O 253.34 80.51 177.87 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography webtpa PPO O 253.34 80.51 177.87 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0401 null revCode Other Imaging Services Diagnostic mammography webtpa Workers Comp O 253.34 80.51 177.87 186.43 152.00 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna EPO I 670.02 147.85 204.64 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna EPO O 549.08 84.08 334.39 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna HMO I 670.02 147.85 204.64 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna HMO O 549.08 84.08 334.39 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna Medicaid I 670.02 147.85 204.64 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna Medicaid O 549.08 84.08 334.39 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna Medicare Part A I 670.02 147.85 204.64 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna Medicare Part A O 549.08 84.08 334.39 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna Medicare Part B I 670.02 147.85 204.64 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna Medicare Part B O 549.08 84.08 334.39 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna POS I 670.02 147.85 204.64 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna POS O 549.08 84.08 334.39 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna PPO I 670.02 147.85 204.64 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna PPO O 549.08 84.08 334.39 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna Workers Comp I 670.02 147.85 204.64 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna Workers Comp O 549.08 84.08 334.39 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna - medicare advantage EPO O 549.08 84.08 84.08 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna - medicare advantage HMO O 549.08 84.08 84.08 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna - medicare advantage Medicaid O 549.08 84.08 84.08 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna - medicare advantage Medicare Part A O 549.08 84.08 84.08 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna - medicare advantage Medicare Part B O 549.08 84.08 84.08 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna - medicare advantage POS O 549.08 84.08 84.08 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna - medicare advantage PPO O 549.08 84.08 84.08 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound aetna - medicare advantage Workers Comp O 549.08 84.08 84.08 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound blue cross blue shield EPO O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound blue cross blue shield HMO O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound blue cross blue shield Medicaid O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound blue cross blue shield Medicare Part A O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound blue cross blue shield Medicare Part B O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound blue cross blue shield POS O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound blue cross blue shield PPO O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound blue cross blue shield Workers Comp O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound blue cross blue shield - medicare advantage EPO O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound blue cross blue shield - medicare advantage HMO O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound blue cross blue shield - medicare advantage Medicaid O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound blue cross blue shield - medicare advantage Medicare Part A O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound blue cross blue shield - medicare advantage Medicare Part B O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound blue cross blue shield - medicare advantage POS O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound blue cross blue shield - medicare advantage PPO O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound blue cross blue shield - medicare advantage Workers Comp O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound cigna EPO O 549.08 84.08 396.44 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound cigna HMO O 549.08 84.08 396.44 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound cigna Medicaid O 549.08 84.08 396.44 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound cigna Medicare Part A O 549.08 84.08 396.44 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound cigna Medicare Part B O 549.08 84.08 396.44 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound cigna POS O 549.08 84.08 396.44 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound cigna PPO O 549.08 84.08 396.44 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound cigna Workers Comp O 549.08 84.08 396.44 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound geha EPO O 549.08 84.08 268.72 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound geha HMO O 549.08 84.08 268.72 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound geha Medicaid O 549.08 84.08 268.72 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound geha Medicare Part A O 549.08 84.08 268.72 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound geha Medicare Part B O 549.08 84.08 268.72 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound geha POS O 549.08 84.08 268.72 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound geha PPO O 549.08 84.08 268.72 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound geha Workers Comp O 549.08 84.08 268.72 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound healthchoice EPO O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound healthchoice HMO O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound healthchoice Medicaid O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound healthchoice Medicare Part A O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound healthchoice Medicare Part B O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound healthchoice POS O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound healthchoice PPO O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound healthchoice Workers Comp O 549.08 84.08 216.32 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana EPO O 549.08 84.08 308.02 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana HMO O 549.08 84.08 308.02 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana Medicaid O 549.08 84.08 308.02 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana Medicare Part A O 549.08 84.08 308.02 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana Medicare Part B O 549.08 84.08 308.02 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana POS O 549.08 84.08 308.02 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana PPO O 549.08 84.08 308.02 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana Workers Comp O 549.08 84.08 308.02 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana - medicare advantage EPO I 670.02 147.85 709.00 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana - medicare advantage EPO O 549.08 84.08 96.51 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana - medicare advantage HMO I 670.02 147.85 709.00 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana - medicare advantage HMO O 549.08 84.08 96.51 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana - medicare advantage Medicaid I 670.02 147.85 709.00 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana - medicare advantage Medicaid O 549.08 84.08 96.51 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana - medicare advantage Medicare Part A I 670.02 147.85 709.00 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana - medicare advantage Medicare Part A O 549.08 84.08 96.51 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana - medicare advantage Medicare Part B I 670.02 147.85 709.00 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana - medicare advantage Medicare Part B O 549.08 84.08 96.51 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana - medicare advantage POS I 670.02 147.85 709.00 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana - medicare advantage POS O 549.08 84.08 96.51 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana - medicare advantage PPO I 670.02 147.85 709.00 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana - medicare advantage PPO O 549.08 84.08 96.51 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana - medicare advantage Workers Comp I 670.02 147.85 709.00 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound humana - medicare advantage Workers Comp O 549.08 84.08 96.51 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound tricare EPO O 549.08 84.08 99.29 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound tricare HMO O 549.08 84.08 99.29 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound tricare Medicaid O 549.08 84.08 99.29 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound tricare Medicare Part A O 549.08 84.08 99.29 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound tricare Medicare Part B O 549.08 84.08 99.29 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound tricare POS O 549.08 84.08 99.29 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound tricare PPO O 549.08 84.08 99.29 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound tricare Workers Comp O 549.08 84.08 99.29 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare EPO I 670.02 147.85 154.48 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare EPO O 549.08 84.08 322.28 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare HMO I 670.02 147.85 154.48 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare HMO O 549.08 84.08 322.28 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare Medicaid I 670.02 147.85 154.48 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare Medicaid O 549.08 84.08 322.28 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare Medicare Part A I 670.02 147.85 154.48 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare Medicare Part A O 549.08 84.08 322.28 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare Medicare Part B I 670.02 147.85 154.48 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare Medicare Part B O 549.08 84.08 322.28 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare POS I 670.02 147.85 154.48 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare POS O 549.08 84.08 322.28 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare PPO I 670.02 147.85 154.48 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare PPO O 549.08 84.08 322.28 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare Workers Comp I 670.02 147.85 154.48 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare Workers Comp O 549.08 84.08 322.28 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare - medicare advantage EPO O 549.08 84.08 95.28 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare - medicare advantage HMO O 549.08 84.08 95.28 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare - medicare advantage Medicaid O 549.08 84.08 95.28 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare - medicare advantage Medicare Part A O 549.08 84.08 95.28 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare - medicare advantage Medicare Part B O 549.08 84.08 95.28 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare - medicare advantage POS O 549.08 84.08 95.28 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare - medicare advantage PPO O 549.08 84.08 95.28 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound united healthcare - medicare advantage Workers Comp O 549.08 84.08 95.28 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound va EPO I 670.02 147.85 147.85 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound va EPO O 549.08 84.08 96.50 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound va HMO I 670.02 147.85 147.85 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound va HMO O 549.08 84.08 96.50 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound va Medicaid I 670.02 147.85 147.85 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound va Medicaid O 549.08 84.08 96.50 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound va Medicare Part A I 670.02 147.85 147.85 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound va Medicare Part A O 549.08 84.08 96.50 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound va Medicare Part B I 670.02 147.85 147.85 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound va Medicare Part B O 549.08 84.08 96.50 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound va POS I 670.02 147.85 147.85 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound va POS O 549.08 84.08 96.50 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound va PPO I 670.02 147.85 147.85 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound va PPO O 549.08 84.08 96.50 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound va Workers Comp I 670.02 147.85 147.85 709.00 402.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound va Workers Comp O 549.08 84.08 96.50 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound webtpa EPO O 549.08 84.08 380.97 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound webtpa HMO O 549.08 84.08 380.97 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound webtpa Medicaid O 549.08 84.08 380.97 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound webtpa Medicare Part A O 549.08 84.08 380.97 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound webtpa Medicare Part B O 549.08 84.08 380.97 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound webtpa POS O 549.08 84.08 380.97 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound webtpa PPO O 549.08 84.08 380.97 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0402 null revCode Other Imaging Services Ultrasound webtpa Workers Comp O 549.08 84.08 380.97 396.44 329.45 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography aetna EPO O 297.86 85.12 87.76 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography aetna HMO O 297.86 85.12 87.76 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography aetna Medicaid O 297.86 85.12 87.76 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography aetna Medicare Part A O 297.86 85.12 87.76 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography aetna Medicare Part B O 297.86 85.12 87.76 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography aetna POS O 297.86 85.12 87.76 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography aetna PPO O 297.86 85.12 87.76 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography aetna Workers Comp O 297.86 85.12 87.76 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography aetna - medicare advantage EPO O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography aetna - medicare advantage HMO O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography aetna - medicare advantage Medicaid O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography aetna - medicare advantage Medicare Part A O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography aetna - medicare advantage Medicare Part B O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography aetna - medicare advantage POS O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography aetna - medicare advantage PPO O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography aetna - medicare advantage Workers Comp O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography blue cross blue shield EPO O 297.86 85.12 167.23 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography blue cross blue shield HMO O 297.86 85.12 167.23 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography blue cross blue shield Medicaid O 297.86 85.12 167.23 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography blue cross blue shield Medicare Part A O 297.86 85.12 167.23 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography blue cross blue shield Medicare Part B O 297.86 85.12 167.23 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography blue cross blue shield POS O 297.86 85.12 167.23 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography blue cross blue shield PPO O 297.86 85.12 167.23 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography blue cross blue shield Workers Comp O 297.86 85.12 167.23 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography blue cross blue shield - medicare advantage EPO O 297.86 85.12 167.23 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography blue cross blue shield - medicare advantage HMO O 297.86 85.12 167.23 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography blue cross blue shield - medicare advantage Medicaid O 297.86 85.12 167.23 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography blue cross blue shield - medicare advantage Medicare Part A O 297.86 85.12 167.23 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography blue cross blue shield - medicare advantage Medicare Part B O 297.86 85.12 167.23 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography blue cross blue shield - medicare advantage POS O 297.86 85.12 167.23 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography blue cross blue shield - medicare advantage PPO O 297.86 85.12 167.23 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography blue cross blue shield - medicare advantage Workers Comp O 297.86 85.12 167.23 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography cigna EPO O 297.86 85.12 165.83 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography cigna HMO O 297.86 85.12 165.83 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography cigna Medicaid O 297.86 85.12 165.83 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography cigna Medicare Part A O 297.86 85.12 165.83 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography cigna Medicare Part B O 297.86 85.12 165.83 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography cigna POS O 297.86 85.12 165.83 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography cigna PPO O 297.86 85.12 165.83 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography cigna Workers Comp O 297.86 85.12 165.83 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography humana EPO O 297.86 85.12 234.56 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography humana HMO O 297.86 85.12 234.56 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography humana Medicaid O 297.86 85.12 234.56 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography humana Medicare Part A O 297.86 85.12 234.56 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography humana Medicare Part B O 297.86 85.12 234.56 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography humana POS O 297.86 85.12 234.56 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography humana PPO O 297.86 85.12 234.56 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography humana Workers Comp O 297.86 85.12 234.56 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography humana - medicare advantage EPO O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography humana - medicare advantage HMO O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography humana - medicare advantage Medicaid O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography humana - medicare advantage Medicare Part A O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography humana - medicare advantage Medicare Part B O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography humana - medicare advantage POS O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography humana - medicare advantage PPO O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography humana - medicare advantage Workers Comp O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography medica EPO O 297.86 85.12 89.98 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography medica HMO O 297.86 85.12 89.98 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography medica Medicaid O 297.86 85.12 89.98 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography medica Medicare Part A O 297.86 85.12 89.98 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography medica Medicare Part B O 297.86 85.12 89.98 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography medica POS O 297.86 85.12 89.98 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography medica PPO O 297.86 85.12 89.98 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography medica Workers Comp O 297.86 85.12 89.98 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography tricare EPO O 297.86 85.12 88.57 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography tricare HMO O 297.86 85.12 88.57 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography tricare Medicaid O 297.86 85.12 88.57 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography tricare Medicare Part A O 297.86 85.12 88.57 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography tricare Medicare Part B O 297.86 85.12 88.57 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography tricare POS O 297.86 85.12 88.57 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography tricare PPO O 297.86 85.12 88.57 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography tricare Workers Comp O 297.86 85.12 88.57 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography united healthcare EPO O 297.86 85.12 223.40 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography united healthcare HMO O 297.86 85.12 223.40 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography united healthcare Medicaid O 297.86 85.12 223.40 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography united healthcare Medicare Part A O 297.86 85.12 223.40 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography united healthcare Medicare Part B O 297.86 85.12 223.40 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography united healthcare POS O 297.86 85.12 223.40 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography united healthcare PPO O 297.86 85.12 223.40 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography united healthcare Workers Comp O 297.86 85.12 223.40 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography united healthcare - medicare advantage EPO O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography united healthcare - medicare advantage HMO O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography united healthcare - medicare advantage Medicaid O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography united healthcare - medicare advantage Medicare Part A O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography united healthcare - medicare advantage Medicare Part B O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography united healthcare - medicare advantage POS O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography united healthcare - medicare advantage PPO O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography united healthcare - medicare advantage Workers Comp O 297.86 85.12 85.12 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography va EPO O 297.86 85.12 88.57 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography va HMO O 297.86 85.12 88.57 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography va Medicaid O 297.86 85.12 88.57 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography va Medicare Part A O 297.86 85.12 88.57 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography va Medicare Part B O 297.86 85.12 88.57 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography va POS O 297.86 85.12 88.57 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography va PPO O 297.86 85.12 88.57 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography va Workers Comp O 297.86 85.12 88.57 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography webtpa EPO O 297.86 85.12 324.25 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography webtpa HMO O 297.86 85.12 324.25 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography webtpa Medicaid O 297.86 85.12 324.25 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography webtpa Medicare Part A O 297.86 85.12 324.25 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography webtpa Medicare Part B O 297.86 85.12 324.25 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography webtpa POS O 297.86 85.12 324.25 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography webtpa PPO O 297.86 85.12 324.25 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography webtpa Workers Comp O 297.86 85.12 324.25 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography worker comp EPO O 297.86 85.12 173.71 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography worker comp HMO O 297.86 85.12 173.71 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography worker comp Medicaid O 297.86 85.12 173.71 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography worker comp Medicare Part A O 297.86 85.12 173.71 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography worker comp Medicare Part B O 297.86 85.12 173.71 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography worker comp POS O 297.86 85.12 173.71 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography worker comp PPO O 297.86 85.12 173.71 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0403 null revCode Other Imaging Services Screening mammography worker comp Workers Comp O 297.86 85.12 173.71 324.25 178.72 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0409 null revCode Other Imaging Services Other blue cross blue shield EPO O 694.51 173.70 173.70 173.70 416.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0409 null revCode Other Imaging Services Other blue cross blue shield HMO O 694.51 173.70 173.70 173.70 416.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0409 null revCode Other Imaging Services Other blue cross blue shield Medicaid O 694.51 173.70 173.70 173.70 416.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0409 null revCode Other Imaging Services Other blue cross blue shield Medicare Part A O 694.51 173.70 173.70 173.70 416.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0409 null revCode Other Imaging Services Other blue cross blue shield Medicare Part B O 694.51 173.70 173.70 173.70 416.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0409 null revCode Other Imaging Services Other blue cross blue shield POS O 694.51 173.70 173.70 173.70 416.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0409 null revCode Other Imaging Services Other blue cross blue shield PPO O 694.51 173.70 173.70 173.70 416.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0409 null revCode Other Imaging Services Other blue cross blue shield Workers Comp O 694.51 173.70 173.70 173.70 416.71 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General aetna EPO I 201.80 67.67 115.77 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General aetna HMO I 201.80 67.67 115.77 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General aetna Medicaid I 201.80 67.67 115.77 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General aetna Medicare Part A I 201.80 67.67 115.77 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General aetna Medicare Part B I 201.80 67.67 115.77 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General aetna POS I 201.80 67.67 115.77 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General aetna PPO I 201.80 67.67 115.77 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General aetna Workers Comp I 201.80 67.67 115.77 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General blue cross blue shield EPO O 187.54 57.76 57.76 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General blue cross blue shield HMO O 187.54 57.76 57.76 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General blue cross blue shield Medicaid O 187.54 57.76 57.76 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General blue cross blue shield Medicare Part A O 187.54 57.76 57.76 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General blue cross blue shield Medicare Part B O 187.54 57.76 57.76 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General blue cross blue shield POS O 187.54 57.76 57.76 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General blue cross blue shield PPO O 187.54 57.76 57.76 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General blue cross blue shield Workers Comp O 187.54 57.76 57.76 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General blue cross blue shield - medicare advantage EPO O 187.54 57.76 69.39 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General blue cross blue shield - medicare advantage HMO O 187.54 57.76 69.39 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General blue cross blue shield - medicare advantage Medicaid O 187.54 57.76 69.39 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General blue cross blue shield - medicare advantage Medicare Part A O 187.54 57.76 69.39 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General blue cross blue shield - medicare advantage Medicare Part B O 187.54 57.76 69.39 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General blue cross blue shield - medicare advantage POS O 187.54 57.76 69.39 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General blue cross blue shield - medicare advantage PPO O 187.54 57.76 69.39 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General blue cross blue shield - medicare advantage Workers Comp O 187.54 57.76 69.39 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General cigna EPO I 201.80 67.67 125.79 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General cigna HMO I 201.80 67.67 125.79 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General cigna Medicaid I 201.80 67.67 125.79 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General cigna Medicare Part A I 201.80 67.67 125.79 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General cigna Medicare Part B I 201.80 67.67 125.79 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General cigna POS I 201.80 67.67 125.79 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General cigna PPO I 201.80 67.67 125.79 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General cigna Workers Comp I 201.80 67.67 125.79 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General humana - medicare advantage EPO I 201.80 67.67 125.37 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General humana - medicare advantage HMO I 201.80 67.67 125.37 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General humana - medicare advantage Medicaid I 201.80 67.67 125.37 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General humana - medicare advantage Medicare Part A I 201.80 67.67 125.37 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General humana - medicare advantage Medicare Part B I 201.80 67.67 125.37 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General humana - medicare advantage POS I 201.80 67.67 125.37 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General humana - medicare advantage PPO I 201.80 67.67 125.37 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General humana - medicare advantage Workers Comp I 201.80 67.67 125.37 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General united healthcare EPO O 187.54 57.76 138.33 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General united healthcare HMO O 187.54 57.76 138.33 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General united healthcare Medicaid O 187.54 57.76 138.33 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General united healthcare Medicare Part A O 187.54 57.76 138.33 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General united healthcare Medicare Part B O 187.54 57.76 138.33 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General united healthcare POS O 187.54 57.76 138.33 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General united healthcare PPO O 187.54 57.76 138.33 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General united healthcare Workers Comp O 187.54 57.76 138.33 138.33 112.52 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General va EPO I 201.80 67.67 67.67 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General va HMO I 201.80 67.67 67.67 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General va Medicaid I 201.80 67.67 67.67 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General va Medicare Part A I 201.80 67.67 67.67 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General va Medicare Part B I 201.80 67.67 67.67 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General va POS I 201.80 67.67 67.67 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General va PPO I 201.80 67.67 67.67 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General va Workers Comp I 201.80 67.67 67.67 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General worker comp EPO I 201.80 67.67 450.98 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General worker comp HMO I 201.80 67.67 450.98 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General worker comp Medicaid I 201.80 67.67 450.98 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General worker comp Medicare Part A I 201.80 67.67 450.98 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General worker comp Medicare Part B I 201.80 67.67 450.98 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General worker comp POS I 201.80 67.67 450.98 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General worker comp PPO I 201.80 67.67 450.98 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0410 null revCode Respiratory Services General worker comp Workers Comp I 201.80 67.67 450.98 450.98 121.08 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0412 null revCode Respiratory Services Inhalation services va EPO I 1801.94 225.87 225.87 225.87 1081.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0412 null revCode Respiratory Services Inhalation services va HMO I 1801.94 225.87 225.87 225.87 1081.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0412 null revCode Respiratory Services Inhalation services va Medicaid I 1801.94 225.87 225.87 225.87 1081.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0412 null revCode Respiratory Services Inhalation services va Medicare Part A I 1801.94 225.87 225.87 225.87 1081.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0412 null revCode Respiratory Services Inhalation services va Medicare Part B I 1801.94 225.87 225.87 225.87 1081.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0412 null revCode Respiratory Services Inhalation services va POS I 1801.94 225.87 225.87 225.87 1081.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0412 null revCode Respiratory Services Inhalation services va PPO I 1801.94 225.87 225.87 225.87 1081.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0412 null revCode Respiratory Services Inhalation services va Workers Comp I 1801.94 225.87 225.87 225.87 1081.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0413 null revCode Respiratory Services Hyperbaric oxygen therapy blue cross blue shield EPO O 730.12 105.64 245.62 245.62 438.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0413 null revCode Respiratory Services Hyperbaric oxygen therapy blue cross blue shield HMO O 730.12 105.64 245.62 245.62 438.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0413 null revCode Respiratory Services Hyperbaric oxygen therapy blue cross blue shield Medicaid O 730.12 105.64 245.62 245.62 438.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0413 null revCode Respiratory Services Hyperbaric oxygen therapy blue cross blue shield Medicare Part A O 730.12 105.64 245.62 245.62 438.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0413 null revCode Respiratory Services Hyperbaric oxygen therapy blue cross blue shield Medicare Part B O 730.12 105.64 245.62 245.62 438.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0413 null revCode Respiratory Services Hyperbaric oxygen therapy blue cross blue shield POS O 730.12 105.64 245.62 245.62 438.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0413 null revCode Respiratory Services Hyperbaric oxygen therapy blue cross blue shield PPO O 730.12 105.64 245.62 245.62 438.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0413 null revCode Respiratory Services Hyperbaric oxygen therapy blue cross blue shield Workers Comp O 730.12 105.64 245.62 245.62 438.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0413 null revCode Respiratory Services Hyperbaric oxygen therapy humana - medicare advantage EPO O 730.12 105.64 105.64 245.62 438.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0413 null revCode Respiratory Services Hyperbaric oxygen therapy humana - medicare advantage HMO O 730.12 105.64 105.64 245.62 438.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0413 null revCode Respiratory Services Hyperbaric oxygen therapy humana - medicare advantage Medicaid O 730.12 105.64 105.64 245.62 438.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0413 null revCode Respiratory Services Hyperbaric oxygen therapy humana - medicare advantage Medicare Part A O 730.12 105.64 105.64 245.62 438.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0413 null revCode Respiratory Services Hyperbaric oxygen therapy humana - medicare advantage Medicare Part B O 730.12 105.64 105.64 245.62 438.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0413 null revCode Respiratory Services Hyperbaric oxygen therapy humana - medicare advantage POS O 730.12 105.64 105.64 245.62 438.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0413 null revCode Respiratory Services Hyperbaric oxygen therapy humana - medicare advantage PPO O 730.12 105.64 105.64 245.62 438.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0413 null revCode Respiratory Services Hyperbaric oxygen therapy humana - medicare advantage Workers Comp O 730.12 105.64 105.64 245.62 438.07 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General blue cross blue shield - medicare advantage EPO O 156.93 22.40 121.83 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General blue cross blue shield - medicare advantage HMO O 156.93 22.40 121.83 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General blue cross blue shield - medicare advantage Medicaid O 156.93 22.40 121.83 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General blue cross blue shield - medicare advantage Medicare Part A O 156.93 22.40 121.83 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General blue cross blue shield - medicare advantage Medicare Part B O 156.93 22.40 121.83 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General blue cross blue shield - medicare advantage POS O 156.93 22.40 121.83 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General blue cross blue shield - medicare advantage PPO O 156.93 22.40 121.83 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General blue cross blue shield - medicare advantage Workers Comp O 156.93 22.40 121.83 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General healthchoice EPO O 156.93 22.40 35.71 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General healthchoice HMO O 156.93 22.40 35.71 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General healthchoice Medicaid O 156.93 22.40 35.71 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General healthchoice Medicare Part A O 156.93 22.40 35.71 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General healthchoice Medicare Part B O 156.93 22.40 35.71 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General healthchoice POS O 156.93 22.40 35.71 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General healthchoice PPO O 156.93 22.40 35.71 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General healthchoice Workers Comp O 156.93 22.40 35.71 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General humana - medicare advantage EPO I 163.61 34.80 230.32 230.32 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General humana - medicare advantage EPO O 156.93 22.40 22.40 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General humana - medicare advantage HMO I 163.61 34.80 230.32 230.32 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General humana - medicare advantage HMO O 156.93 22.40 22.40 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General humana - medicare advantage Medicaid I 163.61 34.80 230.32 230.32 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General humana - medicare advantage Medicaid O 156.93 22.40 22.40 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General humana - medicare advantage Medicare Part A I 163.61 34.80 230.32 230.32 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General humana - medicare advantage Medicare Part A O 156.93 22.40 22.40 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General humana - medicare advantage Medicare Part B I 163.61 34.80 230.32 230.32 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General humana - medicare advantage Medicare Part B O 156.93 22.40 22.40 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General humana - medicare advantage POS I 163.61 34.80 230.32 230.32 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General humana - medicare advantage POS O 156.93 22.40 22.40 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General humana - medicare advantage PPO I 163.61 34.80 230.32 230.32 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General humana - medicare advantage PPO O 156.93 22.40 22.40 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General humana - medicare advantage Workers Comp I 163.61 34.80 230.32 230.32 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General humana - medicare advantage Workers Comp O 156.93 22.40 22.40 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General va EPO I 163.61 34.80 34.80 230.32 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General va HMO I 163.61 34.80 34.80 230.32 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General va Medicaid I 163.61 34.80 34.80 230.32 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General va Medicare Part A I 163.61 34.80 34.80 230.32 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General va Medicare Part B I 163.61 34.80 34.80 230.32 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General va POS I 163.61 34.80 34.80 230.32 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General va PPO I 163.61 34.80 34.80 230.32 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General va Workers Comp I 163.61 34.80 34.80 230.32 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General webtpa EPO O 156.93 22.40 171.77 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General webtpa HMO O 156.93 22.40 171.77 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General webtpa Medicaid O 156.93 22.40 171.77 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General webtpa Medicare Part A O 156.93 22.40 171.77 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General webtpa Medicare Part B O 156.93 22.40 171.77 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General webtpa POS O 156.93 22.40 171.77 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General webtpa PPO O 156.93 22.40 171.77 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General webtpa Workers Comp O 156.93 22.40 171.77 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General worker comp EPO O 156.93 22.40 109.07 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General worker comp HMO O 156.93 22.40 109.07 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General worker comp Medicaid O 156.93 22.40 109.07 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General worker comp Medicare Part A O 156.93 22.40 109.07 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General worker comp Medicare Part B O 156.93 22.40 109.07 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General worker comp POS O 156.93 22.40 109.07 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General worker comp PPO O 156.93 22.40 109.07 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0420 null revCode Physical Therapy General worker comp Workers Comp O 156.93 22.40 109.07 171.77 94.16 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge aetna EPO O 163.61 23.94 73.08 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge aetna HMO O 163.61 23.94 73.08 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge aetna Medicaid O 163.61 23.94 73.08 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge aetna Medicare Part A O 163.61 23.94 73.08 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge aetna Medicare Part B O 163.61 23.94 73.08 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge aetna POS O 163.61 23.94 73.08 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge aetna PPO O 163.61 23.94 73.08 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge aetna Workers Comp O 163.61 23.94 73.08 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge aetna - medicare advantage EPO O 163.61 23.94 24.52 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge aetna - medicare advantage HMO O 163.61 23.94 24.52 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge aetna - medicare advantage Medicaid O 163.61 23.94 24.52 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge aetna - medicare advantage Medicare Part A O 163.61 23.94 24.52 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge aetna - medicare advantage Medicare Part B O 163.61 23.94 24.52 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge aetna - medicare advantage POS O 163.61 23.94 24.52 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge aetna - medicare advantage PPO O 163.61 23.94 24.52 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge aetna - medicare advantage Workers Comp O 163.61 23.94 24.52 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge blue cross blue shield EPO O 163.61 23.94 56.18 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge blue cross blue shield HMO O 163.61 23.94 56.18 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge blue cross blue shield Medicaid O 163.61 23.94 56.18 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge blue cross blue shield Medicare Part A O 163.61 23.94 56.18 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge blue cross blue shield Medicare Part B O 163.61 23.94 56.18 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge blue cross blue shield POS O 163.61 23.94 56.18 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge blue cross blue shield PPO O 163.61 23.94 56.18 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge blue cross blue shield Workers Comp O 163.61 23.94 56.18 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge blue cross blue shield - medicare advantage EPO O 163.61 23.94 49.50 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge blue cross blue shield - medicare advantage HMO O 163.61 23.94 49.50 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge blue cross blue shield - medicare advantage Medicaid O 163.61 23.94 49.50 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge blue cross blue shield - medicare advantage Medicare Part A O 163.61 23.94 49.50 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge blue cross blue shield - medicare advantage Medicare Part B O 163.61 23.94 49.50 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge blue cross blue shield - medicare advantage POS O 163.61 23.94 49.50 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge blue cross blue shield - medicare advantage PPO O 163.61 23.94 49.50 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge blue cross blue shield - medicare advantage Workers Comp O 163.61 23.94 49.50 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge cigna EPO O 163.61 23.94 115.78 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge cigna HMO O 163.61 23.94 115.78 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge cigna Medicaid O 163.61 23.94 115.78 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge cigna Medicare Part A O 163.61 23.94 115.78 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge cigna Medicare Part B O 163.61 23.94 115.78 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge cigna POS O 163.61 23.94 115.78 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge cigna PPO O 163.61 23.94 115.78 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge cigna Workers Comp O 163.61 23.94 115.78 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge humana - medicare advantage EPO O 163.61 23.94 24.55 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge humana - medicare advantage HMO O 163.61 23.94 24.55 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge humana - medicare advantage Medicaid O 163.61 23.94 24.55 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge humana - medicare advantage Medicare Part A O 163.61 23.94 24.55 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge humana - medicare advantage Medicare Part B O 163.61 23.94 24.55 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge humana - medicare advantage POS O 163.61 23.94 24.55 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge humana - medicare advantage PPO O 163.61 23.94 24.55 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge humana - medicare advantage Workers Comp O 163.61 23.94 24.55 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge tricare EPO O 163.61 23.94 29.66 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge tricare HMO O 163.61 23.94 29.66 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge tricare Medicaid O 163.61 23.94 29.66 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge tricare Medicare Part A O 163.61 23.94 29.66 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge tricare Medicare Part B O 163.61 23.94 29.66 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge tricare POS O 163.61 23.94 29.66 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge tricare PPO O 163.61 23.94 29.66 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge tricare Workers Comp O 163.61 23.94 29.66 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge united healthcare EPO O 163.61 23.94 116.87 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge united healthcare HMO O 163.61 23.94 116.87 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge united healthcare Medicaid O 163.61 23.94 116.87 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge united healthcare Medicare Part A O 163.61 23.94 116.87 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge united healthcare Medicare Part B O 163.61 23.94 116.87 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge united healthcare POS O 163.61 23.94 116.87 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge united healthcare PPO O 163.61 23.94 116.87 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge united healthcare Workers Comp O 163.61 23.94 116.87 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge va EPO O 163.61 23.94 23.94 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge va HMO O 163.61 23.94 23.94 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge va Medicaid O 163.61 23.94 23.94 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge va Medicare Part A O 163.61 23.94 23.94 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge va Medicare Part B O 163.61 23.94 23.94 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge va POS O 163.61 23.94 23.94 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge va PPO O 163.61 23.94 23.94 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge va Workers Comp O 163.61 23.94 23.94 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge webtpa EPO O 163.61 23.94 164.70 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge webtpa HMO O 163.61 23.94 164.70 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge webtpa Medicaid O 163.61 23.94 164.70 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge webtpa Medicare Part A O 163.61 23.94 164.70 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge webtpa Medicare Part B O 163.61 23.94 164.70 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge webtpa POS O 163.61 23.94 164.70 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge webtpa PPO O 163.61 23.94 164.70 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge webtpa Workers Comp O 163.61 23.94 164.70 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge worker comp EPO O 163.61 23.94 40.77 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge worker comp HMO O 163.61 23.94 40.77 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge worker comp Medicaid O 163.61 23.94 40.77 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge worker comp Medicare Part A O 163.61 23.94 40.77 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge worker comp Medicare Part B O 163.61 23.94 40.77 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge worker comp POS O 163.61 23.94 40.77 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge worker comp PPO O 163.61 23.94 40.77 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0421 null revCode Physical Therapy Visit charge worker comp Workers Comp O 163.61 23.94 40.77 164.70 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0423 null revCode Physical Therapy Group rate va EPO I 123.86 22.12 22.12 22.12 74.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0423 null revCode Physical Therapy Group rate va HMO I 123.86 22.12 22.12 22.12 74.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0423 null revCode Physical Therapy Group rate va Medicaid I 123.86 22.12 22.12 22.12 74.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0423 null revCode Physical Therapy Group rate va Medicare Part A I 123.86 22.12 22.12 22.12 74.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0423 null revCode Physical Therapy Group rate va Medicare Part B I 123.86 22.12 22.12 22.12 74.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0423 null revCode Physical Therapy Group rate va POS I 123.86 22.12 22.12 22.12 74.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0423 null revCode Physical Therapy Group rate va PPO I 123.86 22.12 22.12 22.12 74.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0423 null revCode Physical Therapy Group rate va Workers Comp I 123.86 22.12 22.12 22.12 74.32 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation aetna EPO I 281.58 64.46 106.81 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation aetna EPO O 212.10 63.35 121.10 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation aetna HMO I 281.58 64.46 106.81 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation aetna HMO O 212.10 63.35 121.10 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation aetna Medicaid I 281.58 64.46 106.81 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation aetna Medicaid O 212.10 63.35 121.10 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation aetna Medicare Part A I 281.58 64.46 106.81 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation aetna Medicare Part A O 212.10 63.35 121.10 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation aetna Medicare Part B I 281.58 64.46 106.81 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation aetna Medicare Part B O 212.10 63.35 121.10 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation aetna POS I 281.58 64.46 106.81 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation aetna POS O 212.10 63.35 121.10 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation aetna PPO I 281.58 64.46 106.81 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation aetna PPO O 212.10 63.35 121.10 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation aetna Workers Comp I 281.58 64.46 106.81 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation aetna Workers Comp O 212.10 63.35 121.10 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation blue cross blue shield EPO O 212.10 63.35 73.08 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation blue cross blue shield HMO O 212.10 63.35 73.08 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation blue cross blue shield Medicaid O 212.10 63.35 73.08 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation blue cross blue shield Medicare Part A O 212.10 63.35 73.08 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation blue cross blue shield Medicare Part B O 212.10 63.35 73.08 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation blue cross blue shield POS O 212.10 63.35 73.08 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation blue cross blue shield PPO O 212.10 63.35 73.08 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation blue cross blue shield Workers Comp O 212.10 63.35 73.08 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage EPO O 212.10 63.35 63.35 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage HMO O 212.10 63.35 63.35 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage Medicaid O 212.10 63.35 63.35 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage Medicare Part A O 212.10 63.35 63.35 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage Medicare Part B O 212.10 63.35 63.35 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage POS O 212.10 63.35 63.35 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage PPO O 212.10 63.35 63.35 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage Workers Comp O 212.10 63.35 63.35 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation cigna EPO I 281.58 64.46 161.49 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation cigna EPO O 212.10 63.35 133.59 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation cigna HMO I 281.58 64.46 161.49 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation cigna HMO O 212.10 63.35 133.59 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation cigna Medicaid I 281.58 64.46 161.49 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation cigna Medicaid O 212.10 63.35 133.59 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation cigna Medicare Part A I 281.58 64.46 161.49 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation cigna Medicare Part A O 212.10 63.35 133.59 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation cigna Medicare Part B I 281.58 64.46 161.49 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation cigna Medicare Part B O 212.10 63.35 133.59 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation cigna POS I 281.58 64.46 161.49 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation cigna POS O 212.10 63.35 133.59 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation cigna PPO I 281.58 64.46 161.49 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation cigna PPO O 212.10 63.35 133.59 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation cigna Workers Comp I 281.58 64.46 161.49 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation cigna Workers Comp O 212.10 63.35 133.59 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation humana - medicare advantage EPO I 281.58 64.46 258.21 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation humana - medicare advantage EPO O 212.10 63.35 95.98 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation humana - medicare advantage HMO I 281.58 64.46 258.21 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation humana - medicare advantage HMO O 212.10 63.35 95.98 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation humana - medicare advantage Medicaid I 281.58 64.46 258.21 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation humana - medicare advantage Medicaid O 212.10 63.35 95.98 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation humana - medicare advantage Medicare Part A I 281.58 64.46 258.21 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation humana - medicare advantage Medicare Part A O 212.10 63.35 95.98 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation humana - medicare advantage Medicare Part B I 281.58 64.46 258.21 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation humana - medicare advantage Medicare Part B O 212.10 63.35 95.98 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation humana - medicare advantage POS I 281.58 64.46 258.21 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation humana - medicare advantage POS O 212.10 63.35 95.98 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation humana - medicare advantage PPO I 281.58 64.46 258.21 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation humana - medicare advantage PPO O 212.10 63.35 95.98 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation humana - medicare advantage Workers Comp I 281.58 64.46 258.21 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation humana - medicare advantage Workers Comp O 212.10 63.35 95.98 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation tricare EPO O 212.10 63.35 82.61 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation tricare HMO O 212.10 63.35 82.61 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation tricare Medicaid O 212.10 63.35 82.61 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation tricare Medicare Part A O 212.10 63.35 82.61 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation tricare Medicare Part B O 212.10 63.35 82.61 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation tricare POS O 212.10 63.35 82.61 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation tricare PPO O 212.10 63.35 82.61 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation tricare Workers Comp O 212.10 63.35 82.61 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation united healthcare EPO O 212.10 63.35 151.50 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation united healthcare HMO O 212.10 63.35 151.50 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation united healthcare Medicaid O 212.10 63.35 151.50 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation united healthcare Medicare Part A O 212.10 63.35 151.50 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation united healthcare Medicare Part B O 212.10 63.35 151.50 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation united healthcare POS O 212.10 63.35 151.50 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation united healthcare PPO O 212.10 63.35 151.50 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation united healthcare Workers Comp O 212.10 63.35 151.50 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation va EPO I 281.58 64.46 64.46 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation va EPO O 212.10 63.35 95.98 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation va HMO I 281.58 64.46 64.46 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation va HMO O 212.10 63.35 95.98 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation va Medicaid I 281.58 64.46 64.46 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation va Medicaid O 212.10 63.35 95.98 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation va Medicare Part A I 281.58 64.46 64.46 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation va Medicare Part A O 212.10 63.35 95.98 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation va Medicare Part B I 281.58 64.46 64.46 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation va Medicare Part B O 212.10 63.35 95.98 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation va POS I 281.58 64.46 64.46 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation va POS O 212.10 63.35 95.98 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation va PPO I 281.58 64.46 64.46 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation va PPO O 212.10 63.35 95.98 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation va Workers Comp I 281.58 64.46 64.46 258.21 168.95 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation va Workers Comp O 212.10 63.35 95.98 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation webtpa EPO O 212.10 63.35 263.00 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation webtpa HMO O 212.10 63.35 263.00 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation webtpa Medicaid O 212.10 63.35 263.00 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation webtpa Medicare Part A O 212.10 63.35 263.00 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation webtpa Medicare Part B O 212.10 63.35 263.00 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation webtpa POS O 212.10 63.35 263.00 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation webtpa PPO O 212.10 63.35 263.00 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation webtpa Workers Comp O 212.10 63.35 263.00 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation worker comp EPO O 212.10 63.35 67.40 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation worker comp HMO O 212.10 63.35 67.40 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation worker comp Medicaid O 212.10 63.35 67.40 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation worker comp Medicare Part A O 212.10 63.35 67.40 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation worker comp Medicare Part B O 212.10 63.35 67.40 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation worker comp POS O 212.10 63.35 67.40 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation worker comp PPO O 212.10 63.35 67.40 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0424 null revCode Physical Therapy Evaluation or reevaluation worker comp Workers Comp O 212.10 63.35 67.40 263.00 127.26 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General aetna EPO I 177.93 30.72 136.53 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General aetna HMO I 177.93 30.72 136.53 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General aetna Medicaid I 177.93 30.72 136.53 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General aetna Medicare Part A I 177.93 30.72 136.53 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General aetna Medicare Part B I 177.93 30.72 136.53 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General aetna POS I 177.93 30.72 136.53 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General aetna PPO I 177.93 30.72 136.53 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General aetna Workers Comp I 177.93 30.72 136.53 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General blue cross blue shield - medicare advantage EPO O 52.60 29.17 82.40 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General blue cross blue shield - medicare advantage HMO O 52.60 29.17 82.40 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General blue cross blue shield - medicare advantage Medicaid O 52.60 29.17 82.40 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General blue cross blue shield - medicare advantage Medicare Part A O 52.60 29.17 82.40 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General blue cross blue shield - medicare advantage Medicare Part B O 52.60 29.17 82.40 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General blue cross blue shield - medicare advantage POS O 52.60 29.17 82.40 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General blue cross blue shield - medicare advantage PPO O 52.60 29.17 82.40 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General blue cross blue shield - medicare advantage Workers Comp O 52.60 29.17 82.40 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General humana - medicare advantage EPO I 177.93 30.72 163.61 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General humana - medicare advantage EPO O 52.60 29.17 29.17 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General humana - medicare advantage HMO I 177.93 30.72 163.61 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General humana - medicare advantage HMO O 52.60 29.17 29.17 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General humana - medicare advantage Medicaid I 177.93 30.72 163.61 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General humana - medicare advantage Medicaid O 52.60 29.17 29.17 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General humana - medicare advantage Medicare Part A I 177.93 30.72 163.61 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General humana - medicare advantage Medicare Part A O 52.60 29.17 29.17 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General humana - medicare advantage Medicare Part B I 177.93 30.72 163.61 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General humana - medicare advantage Medicare Part B O 52.60 29.17 29.17 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General humana - medicare advantage POS I 177.93 30.72 163.61 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General humana - medicare advantage POS O 52.60 29.17 29.17 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General humana - medicare advantage PPO I 177.93 30.72 163.61 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General humana - medicare advantage PPO O 52.60 29.17 29.17 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General humana - medicare advantage Workers Comp I 177.93 30.72 163.61 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General humana - medicare advantage Workers Comp O 52.60 29.17 29.17 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General tricare EPO O 52.60 29.17 46.81 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General tricare HMO O 52.60 29.17 46.81 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General tricare Medicaid O 52.60 29.17 46.81 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General tricare Medicare Part A O 52.60 29.17 46.81 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General tricare Medicare Part B O 52.60 29.17 46.81 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General tricare POS O 52.60 29.17 46.81 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General tricare PPO O 52.60 29.17 46.81 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General tricare Workers Comp O 52.60 29.17 46.81 82.40 31.56 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General va EPO I 177.93 30.72 30.72 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General va HMO I 177.93 30.72 30.72 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General va Medicaid I 177.93 30.72 30.72 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General va Medicare Part A I 177.93 30.72 30.72 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General va Medicare Part B I 177.93 30.72 30.72 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General va POS I 177.93 30.72 30.72 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General va PPO I 177.93 30.72 30.72 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0430 null revCode Occupational Therapy General va Workers Comp I 177.93 30.72 30.72 163.61 106.76 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge aetna EPO O 163.61 23.94 73.47 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge aetna HMO O 163.61 23.94 73.47 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge aetna Medicaid O 163.61 23.94 73.47 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge aetna Medicare Part A O 163.61 23.94 73.47 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge aetna Medicare Part B O 163.61 23.94 73.47 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge aetna POS O 163.61 23.94 73.47 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge aetna PPO O 163.61 23.94 73.47 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge aetna Workers Comp O 163.61 23.94 73.47 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge aetna - medicare advantage EPO O 163.61 23.94 24.45 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge aetna - medicare advantage HMO O 163.61 23.94 24.45 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge aetna - medicare advantage Medicaid O 163.61 23.94 24.45 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge aetna - medicare advantage Medicare Part A O 163.61 23.94 24.45 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge aetna - medicare advantage Medicare Part B O 163.61 23.94 24.45 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge aetna - medicare advantage POS O 163.61 23.94 24.45 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge aetna - medicare advantage PPO O 163.61 23.94 24.45 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge aetna - medicare advantage Workers Comp O 163.61 23.94 24.45 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge blue cross blue shield EPO O 163.61 23.94 62.54 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge blue cross blue shield HMO O 163.61 23.94 62.54 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge blue cross blue shield Medicaid O 163.61 23.94 62.54 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge blue cross blue shield Medicare Part A O 163.61 23.94 62.54 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge blue cross blue shield Medicare Part B O 163.61 23.94 62.54 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge blue cross blue shield POS O 163.61 23.94 62.54 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge blue cross blue shield PPO O 163.61 23.94 62.54 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge blue cross blue shield Workers Comp O 163.61 23.94 62.54 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge blue cross blue shield - medicare advantage EPO O 163.61 23.94 53.70 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge blue cross blue shield - medicare advantage HMO O 163.61 23.94 53.70 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge blue cross blue shield - medicare advantage Medicaid O 163.61 23.94 53.70 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge blue cross blue shield - medicare advantage Medicare Part A O 163.61 23.94 53.70 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge blue cross blue shield - medicare advantage Medicare Part B O 163.61 23.94 53.70 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge blue cross blue shield - medicare advantage POS O 163.61 23.94 53.70 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge blue cross blue shield - medicare advantage PPO O 163.61 23.94 53.70 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge blue cross blue shield - medicare advantage Workers Comp O 163.61 23.94 53.70 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge humana - medicare advantage EPO O 163.61 23.94 24.45 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge humana - medicare advantage HMO O 163.61 23.94 24.45 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge humana - medicare advantage Medicaid O 163.61 23.94 24.45 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge humana - medicare advantage Medicare Part A O 163.61 23.94 24.45 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge humana - medicare advantage Medicare Part B O 163.61 23.94 24.45 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge humana - medicare advantage POS O 163.61 23.94 24.45 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge humana - medicare advantage PPO O 163.61 23.94 24.45 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge humana - medicare advantage Workers Comp O 163.61 23.94 24.45 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge tricare EPO O 163.61 23.94 29.66 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge tricare HMO O 163.61 23.94 29.66 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge tricare Medicaid O 163.61 23.94 29.66 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge tricare Medicare Part A O 163.61 23.94 29.66 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge tricare Medicare Part B O 163.61 23.94 29.66 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge tricare POS O 163.61 23.94 29.66 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge tricare PPO O 163.61 23.94 29.66 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge tricare Workers Comp O 163.61 23.94 29.66 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge united healthcare EPO O 163.61 23.94 116.87 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge united healthcare HMO O 163.61 23.94 116.87 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge united healthcare Medicaid O 163.61 23.94 116.87 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge united healthcare Medicare Part A O 163.61 23.94 116.87 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge united healthcare Medicare Part B O 163.61 23.94 116.87 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge united healthcare POS O 163.61 23.94 116.87 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge united healthcare PPO O 163.61 23.94 116.87 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge united healthcare Workers Comp O 163.61 23.94 116.87 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge va EPO O 163.61 23.94 23.94 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge va HMO O 163.61 23.94 23.94 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge va Medicaid O 163.61 23.94 23.94 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge va Medicare Part A O 163.61 23.94 23.94 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge va Medicare Part B O 163.61 23.94 23.94 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge va POS O 163.61 23.94 23.94 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge va PPO O 163.61 23.94 23.94 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge va Workers Comp O 163.61 23.94 23.94 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge webtpa EPO O 163.61 23.94 147.25 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge webtpa HMO O 163.61 23.94 147.25 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge webtpa Medicaid O 163.61 23.94 147.25 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge webtpa Medicare Part A O 163.61 23.94 147.25 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge webtpa Medicare Part B O 163.61 23.94 147.25 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge webtpa POS O 163.61 23.94 147.25 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge webtpa PPO O 163.61 23.94 147.25 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge webtpa Workers Comp O 163.61 23.94 147.25 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge worker comp EPO O 163.61 23.94 51.99 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge worker comp HMO O 163.61 23.94 51.99 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge worker comp Medicaid O 163.61 23.94 51.99 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge worker comp Medicare Part A O 163.61 23.94 51.99 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge worker comp Medicare Part B O 163.61 23.94 51.99 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge worker comp POS O 163.61 23.94 51.99 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge worker comp PPO O 163.61 23.94 51.99 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0431 null revCode Occupational Therapy Visit charge worker comp Workers Comp O 163.61 23.94 51.99 147.25 98.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation aetna EPO I 357.27 78.40 141.21 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation aetna HMO I 357.27 78.40 141.21 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation aetna Medicaid I 357.27 78.40 141.21 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation aetna Medicare Part A I 357.27 78.40 141.21 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation aetna Medicare Part B I 357.27 78.40 141.21 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation aetna POS I 357.27 78.40 141.21 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation aetna PPO I 357.27 78.40 141.21 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation aetna Workers Comp I 357.27 78.40 141.21 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield EPO O 238.50 83.24 83.24 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield HMO O 238.50 83.24 83.24 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield Medicaid O 238.50 83.24 83.24 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield Medicare Part A O 238.50 83.24 83.24 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield Medicare Part B O 238.50 83.24 83.24 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield POS O 238.50 83.24 83.24 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield PPO O 238.50 83.24 83.24 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield Workers Comp O 238.50 83.24 83.24 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage EPO O 238.50 83.24 122.09 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage HMO O 238.50 83.24 122.09 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage Medicaid O 238.50 83.24 122.09 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage Medicare Part A O 238.50 83.24 122.09 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage Medicare Part B O 238.50 83.24 122.09 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage POS O 238.50 83.24 122.09 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage PPO O 238.50 83.24 122.09 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage Workers Comp O 238.50 83.24 122.09 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage EPO I 357.27 78.40 357.27 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage EPO O 238.50 83.24 87.08 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage HMO I 357.27 78.40 357.27 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage HMO O 238.50 83.24 87.08 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage Medicaid I 357.27 78.40 357.27 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage Medicaid O 238.50 83.24 87.08 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage Medicare Part A I 357.27 78.40 357.27 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage Medicare Part A O 238.50 83.24 87.08 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage Medicare Part B I 357.27 78.40 357.27 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage Medicare Part B O 238.50 83.24 87.08 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage POS I 357.27 78.40 357.27 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage POS O 238.50 83.24 87.08 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage PPO I 357.27 78.40 357.27 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage PPO O 238.50 83.24 87.08 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage Workers Comp I 357.27 78.40 357.27 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage Workers Comp O 238.50 83.24 87.08 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation tricare EPO O 238.50 83.24 87.08 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation tricare HMO O 238.50 83.24 87.08 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation tricare Medicaid O 238.50 83.24 87.08 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation tricare Medicare Part A O 238.50 83.24 87.08 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation tricare Medicare Part B O 238.50 83.24 87.08 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation tricare POS O 238.50 83.24 87.08 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation tricare PPO O 238.50 83.24 87.08 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation tricare Workers Comp O 238.50 83.24 87.08 122.09 143.10 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation va EPO I 357.27 78.40 78.40 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation va HMO I 357.27 78.40 78.40 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation va Medicaid I 357.27 78.40 78.40 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation va Medicare Part A I 357.27 78.40 78.40 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation va Medicare Part B I 357.27 78.40 78.40 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation va POS I 357.27 78.40 78.40 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation va PPO I 357.27 78.40 78.40 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0434 null revCode Occupational Therapy Evaluation or reevaluation va Workers Comp I 357.27 78.40 78.40 357.27 214.36 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General blue cross blue shield EPO O 237.44 54.67 112.88 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General blue cross blue shield HMO O 237.44 54.67 112.88 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General blue cross blue shield Medicaid O 237.44 54.67 112.88 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General blue cross blue shield Medicare Part A O 237.44 54.67 112.88 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General blue cross blue shield Medicare Part B O 237.44 54.67 112.88 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General blue cross blue shield POS O 237.44 54.67 112.88 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General blue cross blue shield PPO O 237.44 54.67 112.88 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General blue cross blue shield Workers Comp O 237.44 54.67 112.88 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General blue cross blue shield - medicare advantage EPO O 237.44 54.67 54.67 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General blue cross blue shield - medicare advantage HMO O 237.44 54.67 54.67 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General blue cross blue shield - medicare advantage Medicaid O 237.44 54.67 54.67 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General blue cross blue shield - medicare advantage Medicare Part A O 237.44 54.67 54.67 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General blue cross blue shield - medicare advantage Medicare Part B O 237.44 54.67 54.67 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General blue cross blue shield - medicare advantage POS O 237.44 54.67 54.67 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General blue cross blue shield - medicare advantage PPO O 237.44 54.67 54.67 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General blue cross blue shield - medicare advantage Workers Comp O 237.44 54.67 54.67 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General humana - medicare advantage EPO I 338.35 83.73 348.50 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General humana - medicare advantage EPO O 237.44 54.67 74.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General humana - medicare advantage HMO I 338.35 83.73 348.50 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General humana - medicare advantage HMO O 237.44 54.67 74.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General humana - medicare advantage Medicaid I 338.35 83.73 348.50 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General humana - medicare advantage Medicaid O 237.44 54.67 74.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General humana - medicare advantage Medicare Part A I 338.35 83.73 348.50 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General humana - medicare advantage Medicare Part A O 237.44 54.67 74.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General humana - medicare advantage Medicare Part B I 338.35 83.73 348.50 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General humana - medicare advantage Medicare Part B O 237.44 54.67 74.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General humana - medicare advantage POS I 338.35 83.73 348.50 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General humana - medicare advantage POS O 237.44 54.67 74.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General humana - medicare advantage PPO I 338.35 83.73 348.50 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General humana - medicare advantage PPO O 237.44 54.67 74.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General humana - medicare advantage Workers Comp I 338.35 83.73 348.50 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General humana - medicare advantage Workers Comp O 237.44 54.67 74.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General tricare EPO O 237.44 54.67 76.83 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General tricare HMO O 237.44 54.67 76.83 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General tricare Medicaid O 237.44 54.67 76.83 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General tricare Medicare Part A O 237.44 54.67 76.83 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General tricare Medicare Part B O 237.44 54.67 76.83 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General tricare POS O 237.44 54.67 76.83 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General tricare PPO O 237.44 54.67 76.83 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General tricare Workers Comp O 237.44 54.67 76.83 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General united healthcare EPO I 338.35 83.73 241.68 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General united healthcare EPO O 237.44 54.67 178.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General united healthcare HMO I 338.35 83.73 241.68 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General united healthcare HMO O 237.44 54.67 178.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General united healthcare Medicaid I 338.35 83.73 241.68 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General united healthcare Medicaid O 237.44 54.67 178.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General united healthcare Medicare Part A I 338.35 83.73 241.68 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General united healthcare Medicare Part A O 237.44 54.67 178.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General united healthcare Medicare Part B I 338.35 83.73 241.68 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General united healthcare Medicare Part B O 237.44 54.67 178.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General united healthcare POS I 338.35 83.73 241.68 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General united healthcare POS O 237.44 54.67 178.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General united healthcare PPO I 338.35 83.73 241.68 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General united healthcare PPO O 237.44 54.67 178.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General united healthcare Workers Comp I 338.35 83.73 241.68 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General united healthcare Workers Comp O 237.44 54.67 178.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General va EPO I 338.35 83.73 83.73 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General va EPO O 237.44 54.67 74.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General va HMO I 338.35 83.73 83.73 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General va HMO O 237.44 54.67 74.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General va Medicaid I 338.35 83.73 83.73 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General va Medicaid O 237.44 54.67 74.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General va Medicare Part A I 338.35 83.73 83.73 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General va Medicare Part A O 237.44 54.67 74.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General va Medicare Part B I 338.35 83.73 83.73 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General va Medicare Part B O 237.44 54.67 74.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General va POS I 338.35 83.73 83.73 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General va POS O 237.44 54.67 74.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General va PPO I 338.35 83.73 83.73 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General va PPO O 237.44 54.67 74.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General va Workers Comp I 338.35 83.73 83.73 348.50 203.01 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0440 null revCode Occupational Therapy General va Workers Comp O 237.44 54.67 74.08 178.08 142.46 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge aetna EPO O 310.29 81.63 232.39 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge aetna HMO O 310.29 81.63 232.39 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge aetna Medicaid O 310.29 81.63 232.39 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge aetna Medicare Part A O 310.29 81.63 232.39 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge aetna Medicare Part B O 310.29 81.63 232.39 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge aetna POS O 310.29 81.63 232.39 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge aetna PPO O 310.29 81.63 232.39 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge aetna Workers Comp O 310.29 81.63 232.39 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge blue cross blue shield EPO O 310.29 81.63 105.98 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge blue cross blue shield HMO O 310.29 81.63 105.98 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge blue cross blue shield Medicaid O 310.29 81.63 105.98 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge blue cross blue shield Medicare Part A O 310.29 81.63 105.98 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge blue cross blue shield Medicare Part B O 310.29 81.63 105.98 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge blue cross blue shield POS O 310.29 81.63 105.98 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge blue cross blue shield PPO O 310.29 81.63 105.98 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge blue cross blue shield Workers Comp O 310.29 81.63 105.98 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge blue cross blue shield - medicare advantage EPO O 310.29 81.63 105.98 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge blue cross blue shield - medicare advantage HMO O 310.29 81.63 105.98 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge blue cross blue shield - medicare advantage Medicaid O 310.29 81.63 105.98 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge blue cross blue shield - medicare advantage Medicare Part A O 310.29 81.63 105.98 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge blue cross blue shield - medicare advantage Medicare Part B O 310.29 81.63 105.98 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge blue cross blue shield - medicare advantage POS O 310.29 81.63 105.98 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge blue cross blue shield - medicare advantage PPO O 310.29 81.63 105.98 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge blue cross blue shield - medicare advantage Workers Comp O 310.29 81.63 105.98 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge humana - medicare advantage EPO O 310.29 81.63 81.63 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge humana - medicare advantage HMO O 310.29 81.63 81.63 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge humana - medicare advantage Medicaid O 310.29 81.63 81.63 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge humana - medicare advantage Medicare Part A O 310.29 81.63 81.63 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge humana - medicare advantage Medicare Part B O 310.29 81.63 81.63 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge humana - medicare advantage POS O 310.29 81.63 81.63 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge humana - medicare advantage PPO O 310.29 81.63 81.63 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge humana - medicare advantage Workers Comp O 310.29 81.63 81.63 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge tricare EPO O 310.29 81.63 84.29 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge tricare HMO O 310.29 81.63 84.29 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge tricare Medicaid O 310.29 81.63 84.29 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge tricare Medicare Part A O 310.29 81.63 84.29 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge tricare Medicare Part B O 310.29 81.63 84.29 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge tricare POS O 310.29 81.63 84.29 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge tricare PPO O 310.29 81.63 84.29 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge tricare Workers Comp O 310.29 81.63 84.29 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge va EPO I 575.42 141.00 141.00 141.00 345.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge va EPO O 310.29 81.63 87.95 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge va HMO I 575.42 141.00 141.00 141.00 345.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge va HMO O 310.29 81.63 87.95 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge va Medicaid I 575.42 141.00 141.00 141.00 345.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge va Medicaid O 310.29 81.63 87.95 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge va Medicare Part A I 575.42 141.00 141.00 141.00 345.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge va Medicare Part A O 310.29 81.63 87.95 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge va Medicare Part B I 575.42 141.00 141.00 141.00 345.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge va Medicare Part B O 310.29 81.63 87.95 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge va POS I 575.42 141.00 141.00 141.00 345.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge va POS O 310.29 81.63 87.95 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge va PPO I 575.42 141.00 141.00 141.00 345.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge va PPO O 310.29 81.63 87.95 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge va Workers Comp I 575.42 141.00 141.00 141.00 345.25 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0441 null revCode Occupational Therapy Visit charge va Workers Comp O 310.29 81.63 87.95 232.39 186.17 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0442 null revCode Occupational Therapy Hourly charge va EPO I 407.71 60.49 60.49 60.49 244.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0442 null revCode Occupational Therapy Hourly charge va HMO I 407.71 60.49 60.49 60.49 244.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0442 null revCode Occupational Therapy Hourly charge va Medicaid I 407.71 60.49 60.49 60.49 244.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0442 null revCode Occupational Therapy Hourly charge va Medicare Part A I 407.71 60.49 60.49 60.49 244.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0442 null revCode Occupational Therapy Hourly charge va Medicare Part B I 407.71 60.49 60.49 60.49 244.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0442 null revCode Occupational Therapy Hourly charge va POS I 407.71 60.49 60.49 60.49 244.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0442 null revCode Occupational Therapy Hourly charge va PPO I 407.71 60.49 60.49 60.49 244.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0442 null revCode Occupational Therapy Hourly charge va Workers Comp I 407.71 60.49 60.49 60.49 244.63 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation aetna EPO I 494.17 119.90 143.31 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation aetna HMO I 494.17 119.90 143.31 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation aetna Medicaid I 494.17 119.90 143.31 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation aetna Medicare Part A I 494.17 119.90 143.31 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation aetna Medicare Part B I 494.17 119.90 143.31 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation aetna POS I 494.17 119.90 143.31 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation aetna PPO I 494.17 119.90 143.31 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation aetna Workers Comp I 494.17 119.90 143.31 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage EPO O 494.17 115.04 115.04 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage HMO O 494.17 115.04 115.04 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage Medicaid O 494.17 115.04 115.04 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage Medicare Part A O 494.17 115.04 115.04 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage Medicare Part B O 494.17 115.04 115.04 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage POS O 494.17 115.04 115.04 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage PPO O 494.17 115.04 115.04 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation blue cross blue shield - medicare advantage Workers Comp O 494.17 115.04 115.04 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation cigna EPO I 494.17 119.90 470.64 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation cigna HMO I 494.17 119.90 470.64 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation cigna Medicaid I 494.17 119.90 470.64 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation cigna Medicare Part A I 494.17 119.90 470.64 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation cigna Medicare Part B I 494.17 119.90 470.64 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation cigna POS I 494.17 119.90 470.64 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation cigna PPO I 494.17 119.90 470.64 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation cigna Workers Comp I 494.17 119.90 470.64 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage EPO O 494.17 115.04 205.38 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage HMO O 494.17 115.04 205.38 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage Medicaid O 494.17 115.04 205.38 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage Medicare Part A O 494.17 115.04 205.38 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage Medicare Part B O 494.17 115.04 205.38 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage POS O 494.17 115.04 205.38 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage PPO O 494.17 115.04 205.38 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation humana - medicare advantage Workers Comp O 494.17 115.04 205.38 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation tricare EPO O 494.17 115.04 188.13 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation tricare HMO O 494.17 115.04 188.13 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation tricare Medicaid O 494.17 115.04 188.13 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation tricare Medicare Part A O 494.17 115.04 188.13 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation tricare Medicare Part B O 494.17 115.04 188.13 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation tricare POS O 494.17 115.04 188.13 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation tricare PPO O 494.17 115.04 188.13 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation tricare Workers Comp O 494.17 115.04 188.13 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation va EPO I 494.17 119.90 119.90 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation va EPO O 494.17 115.04 222.62 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation va HMO I 494.17 119.90 119.90 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation va HMO O 494.17 115.04 222.62 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation va Medicaid I 494.17 119.90 119.90 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation va Medicaid O 494.17 115.04 222.62 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation va Medicare Part A I 494.17 119.90 119.90 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation va Medicare Part A O 494.17 115.04 222.62 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation va Medicare Part B I 494.17 119.90 119.90 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation va Medicare Part B O 494.17 115.04 222.62 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation va POS I 494.17 119.90 119.90 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation va POS O 494.17 115.04 222.62 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation va PPO I 494.17 119.90 119.90 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation va PPO O 494.17 115.04 222.62 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation va Workers Comp I 494.17 119.90 119.90 470.64 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0444 null revCode Occupational Therapy Evaluation or reevaluation va Workers Comp O 494.17 115.04 222.62 222.62 296.50 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General aetna EPO I 891.24 303.56 538.65 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General aetna HMO I 891.24 303.56 538.65 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General aetna Medicaid I 891.24 303.56 538.65 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General aetna Medicare Part A I 891.24 303.56 538.65 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General aetna Medicare Part B I 891.24 303.56 538.65 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General aetna POS I 891.24 303.56 538.65 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General aetna PPO I 891.24 303.56 538.65 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General aetna Workers Comp I 891.24 303.56 538.65 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General cigna EPO I 891.24 303.56 602.76 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General cigna HMO I 891.24 303.56 602.76 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General cigna Medicaid I 891.24 303.56 602.76 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General cigna Medicare Part A I 891.24 303.56 602.76 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General cigna Medicare Part B I 891.24 303.56 602.76 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General cigna POS I 891.24 303.56 602.76 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General cigna PPO I 891.24 303.56 602.76 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General cigna Workers Comp I 891.24 303.56 602.76 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General humana - medicare advantage EPO I 891.24 303.56 637.57 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General humana - medicare advantage HMO I 891.24 303.56 637.57 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General humana - medicare advantage Medicaid I 891.24 303.56 637.57 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General humana - medicare advantage Medicare Part A I 891.24 303.56 637.57 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General humana - medicare advantage Medicare Part B I 891.24 303.56 637.57 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General humana - medicare advantage POS I 891.24 303.56 637.57 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General humana - medicare advantage PPO I 891.24 303.56 637.57 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General humana - medicare advantage Workers Comp I 891.24 303.56 637.57 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General united healthcare EPO I 891.24 303.56 318.40 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General united healthcare HMO I 891.24 303.56 318.40 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General united healthcare Medicaid I 891.24 303.56 318.40 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General united healthcare Medicare Part A I 891.24 303.56 318.40 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General united healthcare Medicare Part B I 891.24 303.56 318.40 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General united healthcare POS I 891.24 303.56 318.40 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General united healthcare PPO I 891.24 303.56 318.40 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General united healthcare Workers Comp I 891.24 303.56 318.40 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General va EPO I 891.24 303.56 303.56 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General va HMO I 891.24 303.56 303.56 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General va Medicaid I 891.24 303.56 303.56 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General va Medicare Part A I 891.24 303.56 303.56 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General va Medicare Part B I 891.24 303.56 303.56 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General va POS I 891.24 303.56 303.56 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General va PPO I 891.24 303.56 303.56 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General va Workers Comp I 891.24 303.56 303.56 637.57 534.74 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General webtpa EPO O 2635.78 536.42 1437.90 1437.90 1581.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General webtpa HMO O 2635.78 536.42 1437.90 1437.90 1581.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General webtpa Medicaid O 2635.78 536.42 1437.90 1437.90 1581.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General webtpa Medicare Part A O 2635.78 536.42 1437.90 1437.90 1581.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General webtpa Medicare Part B O 2635.78 536.42 1437.90 1437.90 1581.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General webtpa POS O 2635.78 536.42 1437.90 1437.90 1581.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General webtpa PPO O 2635.78 536.42 1437.90 1437.90 1581.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General webtpa Workers Comp O 2635.78 536.42 1437.90 1437.90 1581.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General worker comp EPO O 2635.78 536.42 536.42 1437.90 1581.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 0450 null revCode Emergency Room General worker comp HMO O 2635.78 536.42 536.42 1437.90 1581.47 2022-01-12 1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa Comanche County Memorial Hospital 73-6061037 045